4.8 F可视肾镜在飞行人员肾脏小结石中的临床应用

4.8 F visual micro-percutaneous nephrolithotomy for the treatment of renal microlithiasis of aircrew in clinical practice

目的探讨4.8 F可视肾镜在治疗飞行人员肾脏小结石的安全性和临床疗效。方法2017年3月至2021年9月,武警河南省总队医院采用4.8 F可视肾镜治疗飞行员肾脏小结石28例,均为输尿管软镜手术未成功(其中19例因输尿管狭窄难以放置导引鞘无法进镜,9例软镜进入肾脏未找到结石),术中改4.8 F可视肾镜手术。先截石位,患侧插入5 F输尿管导管,并接0.9%氯化钠注射液逆行滴入,建立人工肾积水。再取俯卧位,在超声引导下采用4.8 F可视肾镜,穿刺进入集合系统,找到结石并用钬激光粉碎。结果28例均一期顺利穿刺碎石成功,手术时间13~45 min,平均(18.5±6.5) min。术后2 h复查血常规,血红蛋白下降1.2~3.5 g/L,平均(2.6±0.5) g/L。术后1例出现较重肉眼血尿,经保守治疗后尿液变清。术后3 d复查彩超,无一例出现胸腔积液、肾周积液或周围脏器损伤等严重并发症。术后平均住院时间(3.6±0.7) d。术后1个月复查肾脏CT,均无结石残留,术后3、6个月复查彩超,未见结石复发。结论采用4.8 F可视肾镜治疗飞行人员肾脏小结石安全、有效,尤其在输尿管软镜取石失败时可尝试使用。

ObjectiveTo explore the clinical safety and efficacy of 4.8 F visual micro-percutaneous nephrolithotomy for the treatment of renal microlithiasis of aircrew.MethodsFrom March 2017 to September 2021, 4.8 F visual micro-percutaneous nephrolithotomy were performed to treat renal microlithiasis of 28 cases in Armed Police Forces Hospital of Henan, which underwent flexible ureteroscopy without success, it was difficult to place the guide sheath because of ureteral stricture in 19 cases, or no stones were found in 9 cases. Then, retrograde surgical method was perfromed and patients were placed in lithotomy position, then turned to the prone position to complete the operation.ResultsAll 28 cases were operated successfully in one stage. Mean operative time was (18.5±6.5) min. Hemoglobin decreased by 1.2-3.5 g/L, with an average of (2.6±0.5) g/L, 2 hours after operation. One patient had postoperative severe gross hematuria, after expectant treatment the patient got better. Followed up 3 days after operation, there was no serious complication such as pleural effusion, perirenal effusion or peripheral organ injury. All patients discharged average was (3.6±0.7) d after operation. Followed up 1 month after operation, the renal CT showed no residual stones. Followed up 3 and 6 month after operation, color Doppler ultrasonography showed no recurrence of stones.Conclusion4.8 F visual micro-percutaneous nephrolithotomy-treatment is safe and effective in the treatment of renal microlithiasis of aircrew, especially when flexible ureterosopic lithotripsy fails, it can be tried.