Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study

Objective:To evaluate the effect of ureteral access sheath(UAS)use and calibration change on stone-free rate and complications of retrograde intrarenal surgery(RIRS).Methods:Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included.Firstly,patients were compared after 1:1 propensity score matching,according to UAS usage during RIRS(UAS used[+]87 and UAS non-used[−]87 patients).Then all UAS+patients(n=481)were subdivided according to UAS calibration:9.5-11.5 Fr,10-12 Fr,11-13 Fr,and 13-15 Fr.Primary outcomes of the study were the success and complications of RIRS.Results:Stone-free rate of UAS+patients(86.2%)was significantly higher than UAS−patients(70.1%)after propensity score matching(p=0.01).Stone-free rate increased with higher caliber UAS(9.5-11.5 Fr:66.7%;10-12 Fr:87.0%;11-13 Fr:90.6%;13-15 Fr:100%;p<0.001).Postoperative complications of UAS+patients(11.5%)were significantly lower than UAS−patients(27.6%)(p=0.01).Complications(8.7%)with 9.5-11.5 Fr UAS was lower than thicker UAS(17.2%)but was not statistically significant(p=0.09).UAS usage was an independent factor predicting stone-free status or peri-and post-operative complications(odds ratio[OR]3.654,95%confidence interval[CI]1.314-10.162;OR 4.443,95%CI 1.350-14.552;OR 4.107,95%CI 1.366-12.344,respectively).Conclusion:Use of UAS in RIRS may increase stone-free rates,which also increase with higher caliber UAS.UAS usage may reduce complications;however,complications seemingly increase with higher UAS calibration.

Retrograde intrarenal surgery vs miniaturized percutaneous nephrolithotomy to treat lower pole renal stones 1.5-2.5 cm in diameter

AIM To compare the outcomes of retrograde intrarenal surgery(RIRS) and miniaturized percutaneous nephrolithotomy(mini-PCNL) in treating lower pole(LP) renal stones with a diameter of 1.5-2.5 cm.METHODS A total of 216 patients who underwent mini-PCNL(n = 103) or RIRS n = 113) for LP stones with a diameter of 1.5-2.5 cm were enrolled between December 2015 and April 2017 at the Urology Department of Ningbo Urology and Nephrology Hospital.RESULTS Significant differences were found in the hospital stay(9.39 ± 4.01 vs 14.08 ± 5.26, P < 0.0001) and hospitalization costs(2624.5 ± 513.36 vs 3255.2 ± 976.5, P < 0.0001) between the RIRS and mini-PCNL groups. The mean operation time was not significantly different between the RIRS group(56.48 ± 24.77) and the mini-PCNL group(60.04 ± 30.38, P = 0.345). The stone-free rates at the first postoperative day(RIRS vs mini-PCNL: 90.2% vs 93.2%, P = 0.822) and the second month postoperatively(RIRS vs mini-PCNL: 93.8% vs 95.1%, P = 0.986) were not significantly different.CONCLUSION RIRS and mini-PCNL are both safe and effective methods for treating LP stones with a diameter of 1.5-2.5 cm. RIRS can be considered as an alternative to PCNL for the treatment for LP stones of 1.5-2.5 cm.

Retrograde intrarenal surgery:An expanding role in treatment of urolithiasis

During the past 3 decades,the surgical management of kidney stones has undergone many technological advances and one is the development of the flexible ureteroscopy.The development of this instrument as well as ancillary equipment such as baskets,graspers,and others,and improvements in lithotripsy with Holmium:YAG laser have led to expand its indications with diagnostic and therapeutic management of medical issues of the upper urinary tract such as urolithiasis and urothelial tumors.The objective of this review is to describe its indications and results in the different scenarios for the treatment of urinary stones.

Successful endovascular treatment of transplant intrarenal artery stenosis in renal transplant recipients: Two case reports

Transplant renal artery stenosis(TRAS) is a relatively rare complication after renal transplantation. The site of the surgical anastomosis is most commonly involved, but sites both proximal and distal to the anastomosis may occur, as well. Angioplasty is the gold standard for the treatment of the stenosis, especially for intrarenal lesions. We report two cases of intrarenal TRAS and successful management with angioplasty without stent placement. Both patients were male, 44 and 55 years old respectively, and they presented with elevated blood pressure or serum creatinine within three months after transplantation. Subsequently, they have undergone angioplasty balloon dilatation with normalization of blood pressure and serum creatinine returning to baseline level. Percutaneous transluminal balloon renal angioplasty is a safe and effective method for the treatment of the intrarenal TRAS.

Retrograde intrarenal surgery in pediatric patients

Urinary tract stone disease is seen at a level of 1%-2% in childhood(< 18 years).In recent years,however,there has been a marked increased in pediatric stone disease,particularly in adolescence.A carbohydrateand salt-heavy diet and a more sedentary lifestyle are implicated in this increase.Although stone disease is rare in childhood,its presence is frequently associated with metabolic or anatomical disorders or infectious conditions,for which reason there is a high possibility of post-therapeutic recurrence.Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children,with their expectations of a long life.In children in whom active stone removal is decided on,the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality.Thanks to today's advanced technology,renal stones that were once treated only by surgery can now be treated with minimally in-vasive techniques,from invasion of the urinary system in an antegrade(percutaneous nephrolithotomy) or retrograde(retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery.This compilation study examined studies involving the RIRS procedure,the latest minimally invasive technique,in children and compared the results of those studies with those from other techniques.

Sheathless and fluoroscopy-free retrograde intrarenal surgery:An attractive way of renal stone management in high-volume stone centers

Objective:To evaluate the efficacy and safety of sheathless and fluoroscopy-free flexible ureterorenoscopic laser lithotripsy(FURSL)for treating renal stones.Methods:Between May 2015 and May 2017,135 patients with renal stones treated with sheathless and fluoroscopy-free FURSL were prospectively evaluated.Our technique involved a semirigid ureteroscopic assessment of the ureter,and the guidewire was left in situ to railroad the flexible ureteroscope.A holmium laser was used to fragment and dust the stones;fragments were neither grasped nor collected.Results:The study population consisted of 135 patients including 85 males(62.96%)and 50 females(37.04%)with a mean age of 40.65 years(range:3-70 years)were evaluated.The mean stone size was 17.23 mm(range:8-41 mm).Complete stone-free status was achieved in 122(90.37%)patients and clinically insignificant residual fragments(CIRF)in two(1.48%),while residual stones were still present in 11(8.15%)patients.Postoperative complications occurred in 23(17.4%)cases and were mostly minor,including fever in 17(12.6%),pyelonephritis in four(3.0%),subcapsular hematoma in one(0.7%)and steinstrasse in one(0.7%).These complications were Clavien Ⅰ-Ⅱ,GⅠ in 17(12.6%)patients,GⅡ in five(3.7%),and Clavien Ⅲb in one(0.7%).No major complications were observed.Stone size2 cm,operative time ≥30 min,and lasing time ≥20 min were significantly associated with a higher rate of complications and lower stone-free rates upon univariate analysis(p<0.05).Conclusion:Sheathless and fluoroscopy-free FURSL are effective and safe for renal stone management,especially for stones under 2 cm in diameter.This process is a feasible option for avoiding sheath complications,which can protect surgeons from the negative effects of radiation.

Angiotensin-converting enzyme 2 alleviates liver fibrosis through the renin-angiotensin system

The present letter to the editor is related to the study titled‘Angiotensin-converting enzyme 2 improves liver fibrosis in mice by regulating autophagy of hepatic stellate cells’.Angiotensin-converting enzyme 2 can alleviate liver fibrosis by regulating autophagy of hepatic stellate cells and affecting the renin-angiotensin system.

Retrograde intrarenal surgery for lower pole stones utilizing stone displacement technique yields excellent results

Objective:To evaluate the long-term stone-free rate(SFR)of retrograde intrarenal surgery(RIRS)in the treatment of lower pole renal calculi using only basket relocation and identify independent predictors of stone-free status.Methods:All consecutive patients undergoing RIRS lower pole renal calculi at a single highvolume tertiary center were analyzed retrospectively.Lower pole stones were relocated to the upper pole,where laser lithotripsy was performed.All patients were followed up in the clinic following the surgery and yearly thereafter.The stone-free status was assessed with a combination of an abdominal ultrasound and abdominal X-ray,or an abdominal non-contrast computed tomography if the stones were known to be radiolucent.Results:A total of 480 consecutive patients who underwent RIRS for treatment of lower pole renal calculi,between January 2012 and December 2018,were analyzed from a prospectively maintained database of 3000 ureteroscopies.With a median follow-up time of 18.6 months,the mean SFR was 94.8%.The procedures were unsuccessful in 26(5.4%)patients due to unreachable stones.The median stone size of the unreachable stones was 12 mm(range 10e30 mm).Multivariable logistic regression analysis revealed two predictors of SFR for lower pole stones:a small cumulative stone burden(odds ratio[OR]:0.903,95%confidence interval[CI]:0.867e0.941,p<0.0001)and preoperative ureteral stent insertion(OR:0.515,95%CI:0.318e0.835,pZ0.007).Conclusion:The long-term SFR of RIRS for the treatment of lower pole stones with basket displacement with appropriate patient selection is high.

Massive retroperitoneal hematoma as an acute complication of retrograde intrarenal surgery:A case report

BACKGROUND Retrograde intrarenal surgery(RIRS)has been proven to be a safe and effective treatment modality in large-scale quantitative studies.However,although its safety profile has been established,it also has a potential risk of life-threatening complications.We here describe our experience with a patient who developed a huge periureteral hematoma after RIRS with holmium laser lithotripsy.CASE SUMMARY A 73-year-old woman visited our center with a complaint of gross hematuria.An enhanced computed tomography(CT)scan revealed a 1.5-cm left renal pelvis stone with hydronephrosis.The patient underwent RIRS.During the surgery,a 12/14-Fr ureteral access sheath was applied and a 6-Fr ureteral catheter was indwelled thereafter.On postoperative day 1,she experienced aggravated left flank pain and left lower-quadrant tenderness without rebound tenderness.A follow-up CT scan was taken,which revealed a huge hematoma in the periureteral space,not in the perirenal space,with suspicious contrast medium extravasation.Immediate angiography was performed;however,it showed no evidence of active bleeding.She was conservatively managed with hydration and antibiotic and nonsteroidal anti-inflammatory drug therapy,and was discharged on postoperative day 7.However,she visited our outpatient department with recurrent left flank pain at 5 d from discharge.Ultrasonography confirmed that the double J-stent was intact.To rule out stent malfunction,the stent was changed.Decreased size of the hematoma was observed in the imaging studies,and conservative management for candiduria was performed for 1 wk.CONCLUSION Although RIRS is an effective and safe procedure for the management of renal stones,clinicians should be aware of its potential complications.

Comparison of the trauma between combined retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for upper ureteral calculi

Objective: To compare the trauma between combined retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for upper ureteral calculi. Methods: Patients with upper ureteral calculi who received lithotripsy in Pengzhou Hospital of Traditional Chinese Medicine between February 2015 and March 2017 were selected and randomly divided into two groups;RIRS group received combined retrograde intrarenal surgery and the Mini-PCNL group received mini-percutaneous nephrolithotomy. 3 d after surgery;the contents of liver and kidney function indexes and stress hormones in serum as well as the expression of CD4+T cell transcription factors in peripheral blood were measured. Results: Serum ALT;AST;γ-GT;BUN and Cr contents of RIRS group 3 d after surgery were not significantly different from those of Mini-PCNL group;and HO-1;ET-1;ACTH;Cor and YKL-40 contents in serum as well as RORγt and T-bet mRNA expression in peripheral blood were significantly lower than those of Mini-PCNL group while Gata-3 and Foxp3 mRNA expression in peripheral blood were higher than those of Mini-PCNL group. Conclusion: Combined retrograde intrarenal surgery for upper ureteral calculi activates less stress response and inflammatory response than mini-percutaneous nephrolithotomy.

Renin-angiotensin system inhibitors prescriptions in Chinese hospitalized chronic kidney disease patients

BACKGROUND Many guidelines have recommended renin-angiotensin system inhibitors(RASI)as the first-line treatment for patients with chronic kidney disease(CKD).We studied RASI prescription trends from 2010 to 2019,and analyzed the characteristics associated with RASI prescription in Chinese hospitalized CKD patients.AIM To study the prescription of renin angiotensin system inhibitors in hospitalized patients with CKD in China.METHODS It was retrospectively,cross-sectional reviewed RASI prescriptions in hospitalized CKD patients in China from 2010 to 2019.RASI prescribing trends were analyzed from 2010 to 2019,and bivariate and multivariate logistic regression analyses were conducted to identify characteristics associated with RASI prescription.RESULTS A total of 35090 CKD patients were included,with 10043(28.6%)RASI prescriptions.Among these patients,18919(53.9%)met the criteria for RASI treatments based on the 2012 kidney disease:Improving global outcomes guidelines.Of these,7246(38.3%)patients received RASI prescriptions.RASI prescriptions showed an initial rapid increase from 2011 to 2012,reached its peak around 2015 and 2016,and then exhibited a subsequent slight decreasing trend.Both bivariate and multivariate analyses showed that several characteristics,including the male gender,age less than 60-year-old,nephrology department admission,lower CKD stage,history of hypertension or diabetes,proteinuria,glomerulonephritis as the CKD etiology,and non-acute kidney injury were associated with RASI prescriptions.CONCLUSION The frequency of RASI prescriptions showed an initial increase but a slight decreasing trend in more recent years.CKD patients with certain characteristics such as elderly age,advanced disease stage,surgery department admission,or acute kidney injury were less likely to receive RASI prescriptions.In the application of RASI in hospitalized CKD patients is insufficient.The actual clinical practice needs to be improved.The development of related research is helpful to guide the correct choice of clinical treatment strategy.

CT影像组学机器学习模型预测逆行输尿管软镜碎石术后泌尿系结石清石率

目的观察CT影像组学机器学习(ML)模型预测泌尿系结石经逆行输尿管软镜碎石术(RIRS)后清石率(SFR)的价值。方法 回顾性纳入216例接受RIRS的泌尿系结石患者并将其分为残余组(n=73)及无残余组(n=143)。以单因素及多因素logistic回归分析临床资料及结石CT表现,筛选RIRS后SFR独立预测因素。分别利用窗宽窗位归一化联合最大最小归一化(记为方法 a)、最大最小归一化(记为方法 b)、窗宽窗位归一化(记为方法 c)及无归一化(记为方法 d)对RIRS前腹部CT进行预处理,基于结石最佳影像组学特征建立ML模型[包括支持向量机(SVM)、逻辑回归(LR)和随机梯度下降(SGD)模型]并筛选其中最佳者;行RUSS及改良S. T. O. N. E评分预测RIRS后泌尿系结石SFR;联合独立预测因素及最佳ML模型构建联合模型。评估各模型及评分系统的预测效能。结果 结石数量、最大结石CT值及体积均为RIRS后SFR的独立预测因素(P均<0.05)。以方法 b预处理后图像构建SVM模型的曲线下面积(AUC)最高(0.861),高于RUSS及改良S. T. O. N. E总评分(AUC=0.750、0.759,P均<0.05)而与联合模型的AUC差异无统计学意义(AUC=0.853,P=0.775)。结论 基于最大最小归一化法预处理CT图像构建的影像组学SVM模型可有效预测泌尿系结石经RIRS后SFR。

What have we learned about the kallikrein-kinin and renin-angiotensin systems in neurological disorders?

The kallikrein-kinin system(KKS) is an intricate endogenous pathway involved in several physiological and pathological cascades in the brain. Due to the pathological effects of kinins in blood vessels and tissues, their formation and degradation are tightly controlled. Their components have been related to several central nervous system diseases such as stroke, Alzheimer's disease, Parkinson's disease, multiple sclerosis, epilepsy and others. Bradykinin and its receptors(B1R and B2R) may have a role in the pathophysiology of certain central nervous system diseases. It has been suggested that kinin B1R is up-regulated in pathological conditions and has a neurodegenerative pattern, while kinin B2R is constitutive and can act as a neuroprotective factor in many neurological conditions. The renin angiotensin system(RAS) is an important blood pressure regulator and controls both sodium and water intake. AngⅡ is a potent vasoconstrictor molecule and angiotensin converting enzyme is the major enzyme responsible for its release. AngⅡ acts mainly on the AT1 receptor, with involvement in several systemic and neurological disorders. Brain RAS has been associated with physiological pathways, but is also associated with brain disorders. This review describes topics relating to the involvement of both systems in several forms of brain dysfunction and indicates components of the KKS and RAS that have been used as targets in several pharmacological approaches.

Renin-angiotensin system in the kidney: What is new?

The renin-angiotensin system （RAS） has been known for more than a century as a cascade that regulates body fuid balance and blood pressure. Angiotensin Ⅱ（Ang Ⅱ） has many functions in different tissues; how-ever it is on the kidney that this peptide exerts its main functions. New enzymes, alternative routes for Ang Ⅱformation or even active Ang Ⅱ-derived peptides have now been described acting on Ang Ⅱ AT1 or AT2 recep-tors, or in receptors which have recently been cloned, such as Mas and AT4. Another interesting observation was that old members of the RAS, such as angioten-sin converting enzyme （ACE）, renin and prorenin, well known by its enzymatic activity, can also activate intra-cellular signaling pathways, acting as an outside-in sig-nal transduction molecule or on the renin/（Pro）renin re-ceptor. Moreover, the endocrine RAS, now is also known to have paracrine, autocrine and intracrine action on different tissues, expressing necessary components for local Ang Ⅱ formation. This in situ formation, especially in the kidney, increases Ang Ⅱ levels to regulate blood pressure and renal functions. These discoveries, such as the ACE2/Ang-（1-7）/Mas axis and its antangonistic effect rather than classical deleterious Ang Ⅱ effects, improves the development of new drugs for treating hypertension and cardiovascular diseases.

Renin-angiotensin system blockers-SGLT2 inhibitorsmineralocorticoid receptor antagonists in diabetic kidney disease:A tale of the past two decades!

Several pharmacological agents to prevent the progression of diabetic kidney disease(DKD)have been tested in patients with type 2 diabetes mellitus(T2DM)in the past two decades.With the exception of renin-angiotensin system blockers that have shown a significant reduction in the progression of DKD in 2001,no other pharmacological agent tested in the past two decades have shown any clinically meaningful result.Recently,the sodium-glucose cotransporter-2 inhibitor(SGLT-2i),canagliflozin,has shown a significant reduction in the composite of hard renal and cardiovascular(CV)endpoints including progression of end-stage kidney disease in patients with DKD with T2DM at the top of reninangiotensin system blocker use.Another SGLT-2i,dapagliflozin,has also shown a significant reduction in the composite of renal and CV endpoints including death in patients with chronic kidney disease(CKD),regardless of T2DM status.Similar positive findings on renal outcomes were recently reported as a top-line result of the empagliflozin trial in patients with CKD regardless of T2DM.However,the full results of this trial have not yet been published.While the use of older steroidal mineralocorticoid receptor antagonists(MRAs)such as spironolactone in DKD is associated with a significant reduction in albuminuria outcomes,a novel non-steroidal MRA finerenone has additionally shown a significant reduction in the composite of hard renal and CV endpoints in patients with DKD and T2DM,with reasonably acceptable side effects.

The renin-angiotensin system,mood,and suicide:Are there associations?

Available evidence points to a possible role of the renin-angiotensin system(RAS)in the pathophysiology of mood disorders and suicide.We carried out a critical analysis of literature data regarding this role,with a focus on the proposed association between RAS dysfunction and suicidal behavior.Epidemiological,genetic,and biochemical findings are described,and the pathophysiological hypothesis aiming at explaining the possible relationship between RAS and suicide are discussed.Available findings do support the involvement of the RAS in the neurobiology of suicide,although the exact mechanisms underlying this involvement are still unknown.

输尿管软镜碎石取石术治疗直径≤2 cm的肾结石的疗效及对肾功能和炎症相关指标的影响

目的 分析输尿管软镜碎石取石术(RIRS)治疗肾结石(直径≤2 cm)的疗效及对肾功能和炎症的影响。方法 选取2020年1月-2022年12月该院收治的肾结石(直径≤2 cm)患者194例,采用随机数表法分为超微经皮肾镜取石术(SMP)组(97例)和RIRS组(97例),分别给予SMP和RIRS治疗,两组患者术后均随访1周。比较两组患者手术情况、肾功能、应激反应、炎症相关指标和并发症发生情况。结果RIRS组肾造瘘管留置时间和住院时间短于SMP组,术中出血量少于SMP组,差异均有统计学意义(P <0.05)。两组患者术后1周血清半胱氨酸蛋白酶抑制剂C (Cys-C)、血肌酐(Scr)、尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子-1 (KIM-1)水平,以及术后24 h血清活性氧(ROS)、肾上腺素(AD)、去甲肾上腺素(NA)、促肾上腺皮质激素(ACTH)、脂质过氧化物(LPO)、白细胞介素-6 (IL-6)、前列腺素E2 (PGE2)和超敏C反应蛋白(hs-CRP)水平较术前升高,且RIRS组低于SMP组,差异均有统计学意义(P <0.05)。RIRS组随访期间的并发症总发生率低于SMP组,差异有统计学意义(P <0.05)。结论 与SMP相比,RIRS治疗肾结石(直径≤2 cm),具有创伤小、出血少、肾功能损害小、术后应激反应轻、炎症反应轻和安全性高等优势,可促进患者术后恢复。

Ocular renin-angiotensin system with special reference in the anterior part of the eye

The renin-angiotensin system(RAS) regulates blood pressure(BP) homeostasis, systemic fluid volume and electrolyte balance. The RAS cascade includes over twenty peptidases, close to twenty angiotensin peptides and at least six receptors. Out of these, angiotensin Ⅱ, angiotensin converting enzyme 1 and angiotensin Ⅱ type 1 receptor(AngⅡ-ACE1-AT1R) together with angiotensin(1-7), angiotensin converting enzyme 2 and Mas receptor(Ang(1-7)-ACE2-Mas R) are regarded as the main components of RAS. In addition to circulating RAS, local RA-system exists in various organs. Local RA-systems are regarded as tissue-specific regulatory system accounting for local effects and long term changes in different organs. Many of the central components such as the two main axes of RAS: AngⅡ-ACE1-AT1 R and Ang(1-7)-ACE2-Mas R, have been identified in the human eye. Furthermore, it has been shown that systemic antihypertensive RAS- inhibiting medications lower intraocular pressure(IOP). These findings suggest the crucial role of RAS not only in the regulation of BP but also in the regulation of IOP, and RAS potentially plays a role in the development of glaucoma and antiglaucomatous drugs.

单通道经皮肾镜联合输尿管软镜治疗合并肾盏颈口狭窄的复杂肾结石疗效观察

目的 探讨单通道经皮肾镜取石术(PCNL)联合输尿管软镜碎石术(RIRS)治疗合并肾盏颈口狭窄的复杂性肾结石的安全性及疗效。方法 回顾性分析2019年7月至2022年2月金华市中心医院收治的26例合并肾盏颈口狭窄的复杂性肾结石患者。所有患者均存在不同程度肾盏颈口狭窄伴肾盏积水,其中狭窄位于上盏21例,中盏3例,下盏2例;3例双侧肾结石,14例肾及输尿管多发结石,18例鹿角形结石。结石大小(40.6±13.5)mm,CT值(1 124.7±364.0)HU,结石负荷评分系统评分(8.7±0.8)分。所有患者均采用顺行PCNL联合RIRS。结果 26例患者均顺利完成手术并扩张狭窄通道留置双J管,平均手术时间(110.8±36.2)min。术中、术后均无严重出血和感染并发症。泌尿手术后并发症评分系统Ⅰ、Ⅱ级并发症发生率分别为7.7%(2例)、15.4%(4例),无Ⅲ级以上并发症。术后1个月复查腹部CT,一期结石取净率80.8%(21/26),二期结石取净率92.3%(24/26)。术后2~14 d拔除肾造瘘管,术后1~3个月拔除双J管。术后随访3~12个月,未见狭窄复发。结论 PCNL联合RIRS治疗合并肾盏颈口狭窄复杂性肾结石可有效扩张狭窄通道,结石取净率高且并发症少,是一种安全有效的治疗方案。

靶盏预处理技术在双镜联合治疗完全型鹿角形结石中的应用价值

目的探讨采用输尿管软镜靶盏预处理技术行一期输尿管软镜联合经皮肾镜钬激光碎石治疗完全型鹿角形结石的安全性和有效性。方法回顾性分析2019年10月~2021年9月采用输尿管软镜联合经皮肾镜手术治疗21例完全型鹿角形结石的临床资料,结石位于左侧8例,右侧12例,双侧结石一期处理右肾结石1例。结石密度(1101±185)HU。手术采用双人双镜操作,全身麻醉,斜仰卧截石位,结合术前影像学检查设计肾穿刺靶盏,输尿管软镜将靶盏内结石击碎,暴露乳头穹隆位置,经皮对靶盏穹隆精准穿刺扩张,直视下建立F_(18)或F_(20)经皮肾通道,双镜联合完成手术。结果本组21例手术均一期顺利完成,手术时间85~158(121.8±21.2)min,术后血红蛋白降低值(9.38±4.36)g/L,术后住院时间3~7(4.4±1.4)d,一期结石清除率85.7%(18/21)。并发症6例,包括术中出血需输血1例,发热3例,胸腔积液1例,术后术区疼痛需要镇痛治疗1例。结论对于完全型鹿角形结石,利用输尿管软镜将靶盏结石预处理后再穿刺建立经皮肾工作通道,手术成功率及一期结石清除率高,经皮肾通道数量少,提高手术安全性。