评估经输尿管镜处理输尿管结石并发症

Analysis of complications following semirigid ureteroscopy lithotripsy for the treatment of ureteral stones

目的:利用改良Satava classification system评估新疆维吾尔自治区医院及江西新余地区医院经输尿管镜处理输尿管结石的经验及并发症。方法:回顾性分析1 563例经输尿管镜处理输尿管结石的患者(男877例,女686例),根据改良Satava classification system评估手术并发症分为1~3级,1级为有并发症但不需处理没有任何不良后果的,2级为并发症需要经内镜在术中处理(2a)或术后内镜处理的(2b),3级为并发症需要开放或腹腔镜处理的。结果:经输尿管镜碎石取石术后完全取出或结石碎片自行排出的1 348例(86.2%)。手术并发症总发生率为216例(13.8%),其中输尿管上段结石移位进入肾盂为4.6%,黏膜损伤3.8%,出血2.3%,输尿管镜不能进入到达结石部位2.1%,黏膜下假道3.15%,输尿管穿孔1.15%,输尿管撕裂伤脱套0.13%。根据改良Satava classification system评估:1级的为4.9%,2级a为4.6%,b为3.74%,3级为0.56%。结论:改良Satava classification system对于经输尿管镜处理输尿管结石出现的并发症严重程度有较好的描述作用,可指导正确的临床处理和评估并发症的预后,同时也可以用来与其他文献比较而更好的服务于临床工作。

Objective :To revie wi ntraoperati ve co mplicati ons foll o wi ng ureteroscopy lithotri psy (URL )accordi ng to our experience with URL i n the treat ment of ureteral stones and stratify i ntraoperati ve co mplicati ons foll o wi ng URL accordi ng to the modified Satava classificati on syste m.Methods :The cli nical data of 1 563 patients (877 males and 686 fe males )were retrospecti vel y .Intraoperati ve co mplicati ons were recorded accordi ng to modified Satava clas-sificati on syste m.Grade 1 co mplicati ons i ncl uded i nci dents without consequences for the patients ;grade 2 co mplica-ti ons ,which are treated i ntraoperati vel y with endoscopic surgery (grade 2a )or required endoscopic re-treat ment (grade 2 b );and grade 3 co mplicati ons i ncl uded i nci dents requiri ng open or laparoscopic surgery .Results :The stones were co mpletel y re moved i n 1 348 (86.3 %).The overall i nci dence of i ntraoperati ve co mplicati ons was 1 3.8 %.The most co mmon co mplicati ons were proxi mal stone mi grati on (4.6 %),mucosal i nj ury (3.8 %),bleedi ng (2.3 %), i nability to reach stone (2 .1 %),ureteral perforati on (1 .1 5 %)and ureteral avulsi on (0.1 3 %),mucosal tears or false-route (3.1 5 %).Accordi ng to modified Satava classificati on syste m,grade 1 accounted for 4.9 %,grade 2a for 4.6 %,grade 2 b for 3.74 %,and grade 3 for 0.56 % respecti vel y .Conclusions :Modified Satava classificati on is a quick and si mple syste m for usi ng to descri b the severity of i ntraoperati ve URL co mplicati ons and this gradi ng sys-te m will hel p to co mpare for the available surgical outco mes fro m different centers .