结石CT值测定联合输尿管软镜单次治疗大负荷肾结石  

The combination of the CT value measurement and flexible ureteroscopy for a single treatment of heavy stone burdens of kidney

作　　者：陶水祥[1] 吴钢峰[1] 骆振刚[1] 应向荣[1] 张关富[1] 阎家骏[1] 

机构地区：[1]绍兴市人民医院泌尿外科,312000

出　　处：《中华腔镜外科杂志（电子版）》2015年第5期32-34,共3页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨结石CT值测定联合输尿管软镜单次治疗大负荷肾结石的安全性,有效性,可行性。方法通过结石CT值测定筛选〈800 HU的直径〉2 cm的肾结石患者16例。术前2周于膀胱镜下留置双J管,全身麻醉下行输尿管软镜钬激光碎石术,术后次日复查KUB,2周后复查CT明确碎石效果。结石残块≥4 mm为有意义结石残留,留置双J管至术后1个月再次复查KUB或CT,如仍有≥4 mm碎石则行体外冲击波碎石术。结果 15例手术成功,1例术后有残余结石,直径8 mm,行体外冲击波碎石术后3周排出。手术时间30-90 min,平均40 min。所有病例均无二次手术。2例术后有发热,经加强抗感染输液对症处理后,体温降至正常。无输尿管穿孔、出血等重大并发症,术后住院2-4 d出院,平均2.4 d。结论结石CT值测定联合输尿管软镜单次治疗大负荷肾结石安全有效、可行。大负荷的肾结石,选择合适的病例进行合适的治疗相当重要。Objectives To appraise the safety,the efficacy and the feasibility of the combined the CT value measurement and flexible ureteroscopy for a single treatment of heavy stone burdens of kidney.Methods We choosed 16 cases of patients with kidney stones whose CT value measurement〈 800 HU.We routinely present the patient 2 weeks preoperation,and underwent flexible ureterorenoscopy（ URS） /holmium laser lithotripsy for renal stones under general anesthesia. KUB and CT were taken postoperative day and 2 weeks,respectively. meaningful Residual fragments defined as greater than 4 mm,which underwent extracorporeal shock wave lithotripsy. Results 15 cases were successful. 1 case has a residual stone,which has 8 mm in diameter,and three weeks later residual stone discharged after extracorporeal shock wave lithotripsy. Operation time 30-90 minutes,mean 40 minutes. All cases were no secondary surgery. 2 cases had fever postoperative,and temperature drop to normal after receiving antibiotics. No major complication such as ureter perforation,and bleeding. Stay hospital time from 2 to 4 days（ mean 2. 4 days）. Conclusions The combination of CT value measurement and flexible ureteroscopy for a single treatment of heavy stone burdens of kidney is effective and feasible for the treatment of large burden kidney stones. It＇s more important to choose appropriate cases for proper treatment.

关 键 词：大负荷 肾结石 CT值 输尿管软镜 单次 

分 类 号：R699[医药卫生—泌尿科学]