输尿管软镜治疗肾输尿管结石技巧探索(附860例报告)

Skills of flexible ureteroscope in the treatment of renal and ureteral calculi(a report of 860 cases)

目的:探讨输尿管软镜治疗肾输尿管结石的有效性、安全性,在临床实践中探索软镜手术技巧。方法:2014年3月~2016年4月,应用输尿管软镜结合钬激光治疗肾输尿管结石860例,其中单纯性肾结石406例,结石直径(1.45±0.46)cm,单纯性输尿管结石178例,结石直径(0.92±0.24)cm,肾及输尿管结石276例,其中肾结石直径(0.91±0.47)cm,输尿管结石直径(0.85±0.23)cm。结果:术前均不预先留置双J管,一期手术成功率98.84%,一次性进鞘成功率96.28%,二次碎石率2.21%,手术时间(61.72±31.20)min,术中出血量(3.40±2.88)ml,术后住院时间(5.30±3.33)d(不包括再次手术者),术后并发症发生率11.86%,术后1个月清石率72%,术后3个月清石率86%。结论:输尿管软镜结合钬激光治疗肾输尿管结石安全、有效、成功率高、术后恢复快、并发症少;一期手术成功率高;碎石困难者经过手术技巧改良,成功率明显提高。

Objective: To discuss the effectiveness and safety of flexible ureteroscope in the treatment of renal and ureteral calculi and investigate the techniques of the procedure with flexible ureteroscope during clinical practice. Methods: Between March 2014 and April 2016, 860 cases of renal and ureteral calculi were treated with flexible ureteroscope combined with holmium laser treatment, including 406 cases of simple renal calculi with(1. 45±0. 46) cm in diameter and 178 cases of simple ureteral calculi with(0. 92±0. 24) cm in diameter,and 276 cases of renal and ureteral calculi [including renal calculi of(0. 91±0. 47) cm in diameter and ureteral calculi of(0. 85±0. 23) cm in diameter]. Results: Double-J tube was not placed before operation. The success rate of one-stage operation was 98. 84%. The success rate of sheath placement at a single attempt was 96. 28%. The incidence of another lithotripsy was 2. 21%. The duration of operation was(61. 72±31. 20) min. The volume of blood loss during operation was(3. 40±2. 88) mL. The duration of hospitalization after operation was(5. 30±3. 33) days(excluding patients with another operation). The incidence of complications after operation was 11. 86%. The percentage of patients without calculus one month after operation was 72%.The percentage of patients without calculus 3 months after operation was 86%.Conclusions: The flexible ureteroscope combined with holmium laser treatment was safe and effective for renal and ureteral calculus,which features high success rate and rapid recovery after operation and less complications. The success rate of one-stage operation was high. For patients whose calculi are difficult to break,the modification of operation technique can significantly improve the success rate.