输尿管软镜下钬激光碎石治疗输尿管上段结石伴肾功能不全的临床研究  

Clinical study of flexible uroteroscope holmium lithotripsy for the treatment of upper urethral calculus associated renal insufficicncy

作　　者：李远伟[1] 吴万瑞[1] 刘哲[1] 陈佳[1] 卢强[1] 李卓[1] 廖智[1] 任伟刚[1] 

机构地区：[1]湖南省人民医院(湖南师范大学第一附属医院)泌尿外科,湖南长沙410005

出　　处：《国际泌尿系统杂志》2014年第6期802-804,共3页International Journal of Urology and Nephrology

摘　　要：目的 探讨输尿管软镜下钬激光碎石在输尿管上段结石伴肾功能不全患者中应用的有效性和安全性.方法 回顾性分析了2012年12月至2014年2月间,采用输尿管软镜下钬激光碎石术治疗输尿管上段结石伴肾功能不全患者19例,年龄28-72岁,平均55岁,经腹部平片（KUB）、CT平扫确诊为输尿管上段结石,结石直径约8-12mm（平均10.1mm）.所有患者一期先在局麻下行患侧双J管内置术,置管2-4周后行输尿管软镜下钬激光碎石.术后留置双J管2-4周.术后1-2d、1个月和3个月复查腹平片或泌尿系超声或CT,观察是否有残留结石,血清肌酐（Cre）评判肾功能变化.结果 所有患者一期局麻下留置双J管成功,输尿管软镜均顺利进镜,一次碎石成功.手术时间为36- 85 min,平均时间58.6min.术后住院天数3-10d,平均6d.术后2d排石率为52.6％（10/19）,术后1个月排石率为84.2％（16/19）,术后3个月排石率为94.7％（18/19）.输尿管软镜钬激光碎石术前最低血清肌酐水平155 - 590.8μmol/L,平均为243.6μmol/L.2例患者输尿管软镜术后出现肾功能不全情况较术前升高,术后6d恢复至术前水平,其余患者术后血清肌酐较术前逐渐下降,但仍高于正常值.本组术中及术后未出现重大并发症.5例术后出现发热大于38℃,经积极治疗后恢复正常.结论 输尿管上段结石伴肾功能不全患者,实施输尿管软镜下钬激光碎石的手术风险高,采用一期局麻下行双J管内引流术做好术前准备,二期输尿管软镜下钬激光碎石术,其疗效满意,安全性可靠.Objectives To evaluate the efficacy and safety of flexible ureteroscopic holmium laser lithotripsy for proximal ureteral calculi in the patients with renal insufficiency.Methods Between December 2012 and February 2014,A total of 19 patients,with a mean age of 55 years （range 28 -72）,underwent flexible ureteroscopic holmium：YAG laser lithotripsy for proximal ureteral calculi with renal insufficiency,patients were examined by kidney-ureter-bladder abdominal radiography and abdominal computed tomography （CT）,The average size of the stones treated was 10.1 mm（range 8-12 mm） in diameter,Internal ureteral stenting （double J stent） was performed firstly,Secondary procedures （flexible ureteroscope holmium laser lithotripsy）were performed in 2 -4 weeks later,Double J stent was removed in 2 -4 weeks.Residual stones were examined by abdominal plain film or urinary tract ultrasound or urinary CT on the first or second post？operative days,1 months and 3 months respectively.the serum creatinine level was used as a marker of renal function.Results The average operation time was 58.6 minutes （range 36-85minutes）,The average hospital stay was 6 days （range 3 - 10days）,The stone-free rate was 52.6％ （10/19）,84.2％ （16/19）,94.7％ （18/19） in postoperatively 2 days,1 month,3 month respectively.the lowest serum creatinine level is 155 - 590.8 μmol/L（average was 243.6 μmol） before Flexible ureteroscope lithotripsy.serum creatinine level increased in 2 cases after operation,and it returned to the preoperative level in postoperative 6 days,serum creatinine level gradually improvement in all other cases,but still higher than normal value.There were no major complications.Postoperative fever ＞38℃ occurred in five cases and recovered after intravenous administration of antibiotics.Conclusions The operation risk is higher in the proximal ureteral calculi patients with renal insufficiency,Ureteral stent placement under local anesthesia for obstructing stones firstly and flexible uretero

关 键 词：输尿管结石 激光 固体 碎石术 激光 肾功能不全 

分 类 号：R693.4[医药卫生—泌尿科学]