输尿管软镜下钬激光碎石取石术治疗43例HIV阳性患者的疗效及安全性分析

Efficacy and safety of flexible ureteroscopy combined with holmium laser lithotripsy for renal or ureteral calculi in 43 HIV positive patients

目的探讨纤维输尿管软镜钬激光碎石技术对人免疫缺陷病毒(HIV)感染阳性患者上尿路结石的治疗疗效及安全性。方法回顾性分析北京地坛医院2016年5月至2018年5月收治43例HIV阳性肾及输尿管上段结石患者行经尿道输尿管软镜钬激光碎石取石术治疗的临床资料。43例患者中双侧肾结石1例,单侧肾结石19例,单侧输尿管上段结石23例。术前均留置输尿管支架管1周,术中应用输尿管软镜引导鞘,采用输尿管软镜钬激光碎石,术后1个月统计患者结石清除率,手术残存结石采用二期软镜再次碎石。结果输尿管软镜引导鞘置入顺利,手术时间约32～125min,平均手术时间(67±4)min。术后住院3～5d,中位数3.5d。43例患者中42例一期碎石排石,清除率为97.7%(42/43)。其中1例患者二期碎石。HIV阳性患者术前检查CD4+T淋巴细胞计数及病毒载量,术后1天复查,与术前比较差异均无统计学意义(P>0.05)。结论 HIV阳性肾及输尿管上段结石患者经尿道输尿管软镜钬激光碎石取石治疗安全、有效,疗效满意、并发症少,可作为HIV阳性感染患者治疗的优选。

Objective To explore the efficacy and safety of flexible ureteroseopy combined with holmium laser lithotripsy for renal or ureteral calculi in HIV positive patients.Methods The clinical data of 43 HIV positive patients with renal or upper ureteral calculi treated with flexible ureteroscopy combined with holmium laser lithotripsy in our hospital during May 2016 and May 2018 were retrospectively analyzed.There were 1 case with bilateral renal calculi,19 cases with unilateral renal calculi,and 23 cases with unilateral upper ureteral calculi.The ureteral stent was inserted1 week before surgery.During surgery,flexible ureteroscopy channel sheath was used,and stones were fragmented by holmium laser.One month after surgery,the stone removal and stone free rate were recorded.Residual stones were re-treated with a secondary lithotripsy.Results The flexible ureteroscopy channel sheath was successfully indwelled in all cases.The average operation time was 67±4 min(ranging 32-125 min).The postoperative stay was 3-5 days(median 3.5 d).Of the 43 patients,42 underwent first-stage lithotripsy,and1 patient underwent a second one.The one-month stone free rate was 97.7%(42/43).There were no statistical differences in the number of CD4+T lymphocytes and viral loads before and 1 day after lithotripsy.Conclusions Flexible ureteroscopy combined with holmium 1 aser lithotripsy is safe and effective in the treatment of renal or ureteral calculi in HIV positive patients.It has high curative effects but few incidences,and can lower the doctors and nurses’risk of exposure.