电子输尿管软镜处理较大肾结石的应用体会  

Application of electronic flexible ureteroscope in treatment of larger kidney stones

作　　者：杨俊杰[1] 王洛夫[1] 兰卫华[1] 张克勤[1] 万江华[1] 聂志林[1] 曹全富[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所泌尿外科,重庆400042

出　　处：《局解手术学杂志》2014年第5期468-470,共3页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的：探讨电子输尿管软镜下钬激光碎石术处理大于2.0cm肾结石的疗效及安全性。方法2012年10月至2013年12月我院采用电子输尿管软镜（OlympusV5）下钬激光碎石术治疗直径≥2.0cm的肾结石的43例患者。所有患者术前预先留置F5双J管1-2周。术中先用F8.0/9.8输尿管硬镜留置导丝,沿导丝置入输尿管软镜输送鞘,再引入输尿管软镜进行钬激光碎石,尽可能将结石粉末化,直径大于3mm的结石碎屑尽可能用套石网篮取出。结果43例患者结石长径2.0-3.2cm,平均2.4cm。一次进镜成功率95.3%（41/43）,2例因输尿管腔狭小未能一期行输尿管软镜手术。手术时间35-120min,平均68min。术后3例出现寒战、发热等感染症状,经积极抗感染治疗后好转,无严重出血等并发症。术后住院2-4d,平均3.2d。术后12周随访,结石清除率86%（37/43）。结论电子输尿管软镜钬激光碎石术治疗≥2.0cm肾结石,安全、有效,特别适用于高龄、孤立肾、既往有切开取石或经皮肾镜术后复发肾结石的患者。Objective To investigate the efficacy and safety of electronic flexible ureteroscope Holmium laser lithotripsy in the treatment＆amp;nbsp;of kidney stones larger than 2. 0 cm. Methods From October 2012 to December 2013,43 cases of kidney stones larger than 2. 0 cm in diam-eter were treated with holmium laser lithotripsy under electronic flexible ureteroscope. A double-J stent was indwelled in ureter for 1-2 weeks before operation in each patient. Ureteral catheter guide wire was firstly put into the ureter with F8. 0/9. 8 semi-rigid ureteroscope,and the ac-cess sheath was put along the wire. Then,the electronic flexible ureteroscope（Olympus V5） was introduced into the pelvis. Stones were frag-mented with holmium laser,and greater than 3 mm crushed stones were removed with a set of stone basket. Results The diameter of the stones of the 43 patients ranged from 2-3. 2 cm,with an average of 2. 4 cm. The operation time ranged from 35-120 min,with an average of 68 min. Three patients complicated with chills,fever and other symptoms of infection,who were improved by active anti-infective treatment. No serious complications occurred. Postoperative hospital stay was 2-4 d,with an average of 3. 2 d. After 12 weeks of follow-up,stone clearance rate was 86% （37/43）. Conclusion It is safe and efficacy to treat kidney stones larger than 2. 0 cm with electronic flexible ureteroscope, especially for the elderly,solitary kidney,and patients with a previous incision or percutaneous nephrolithotomy.

关 键 词：肾结石 电子输尿管软镜 钬激光 

分 类 号：R692.4[医药卫生—泌尿科学]