多中心逆行经硬性软性输尿管镜下钬激光一期治疗双侧上尿路结石145例小结  

Use of Retrograde Rigid and Flexible Ureteroscopy Combined with Holmium Laser Lithotripsy in One-stage Treatment of Calculi of Bilateral Urinary Tract

作　　者：潘东亮[1] 刘乃胜[2] 李清峰 董礼明[4] 晋连超[1] 杨冰[1] 周哲[1] 李宁忱[1] 张祥华[1] 

机构地区：[1]北京大学首钢医院泌尿外科/北京大学吴阶平泌尿外科医学中心,北京100144 [2]天津市东丽区东丽医院泌尿外科,天津300300 [3]北京市门头沟区中医医院外科,北京102300 [4]威海市文登中心医院泌尿外科,威海264400

出　　处：《中国医药导刊》2015年第12期1205-1207,1211,共4页Chinese Journal of Medicinal Guide

基　　金：中国科学院环境化学与生态毒理学国家重点实验室开放基金(KF2011-12);课题名称:多氯联苯暴露对前列腺癌发生发展的效应与机制

摘　　要：目的报道逆行经硬性软性输尿管镜下钬激光一期治疗双侧上尿路结石145例的经验并评价其效果.方法：我们2012年1月～2015年5月一期治疗145例双侧上尿路结石患者,年龄25～61岁,平均（46±9.7）岁.71例主诉单侧腰腹痛,28例为肉眼或镜下血尿,31例为反复发作的尿路感染,15例为意外发现.一侧输尿管结石对侧肾结石78例,双侧肾结石67例.术前留置7Fr输尿管支架1周.术中首先处理输尿管结石侧和双侧肾结石中结石负荷较小的一侧,以Olympus 8/9Fr硬性输尿管镜和科医人100＋W钬激光机粉碎输尿管结石,应用7.9Fr软性输尿管镜粉碎肾结石,手术时间控制在120分钟左右.术后常规留置7Fr D-J管3个月.术后3个月末查KUB评估结石排净率,仍残留较大结石的,行第二次手术碎石.结果：本组145例均安全经受手术,手术成功率100%.硬性软性输尿管镜-期净石134/145（92.4%）;11例肾结石残留行二期单侧经皮肾镜碎石取石.术后尿液均清亮,128例术后第2～4天出院,27例术后0～1天发热行抗生素治疗3～8天后消退出院,未发生其他手术并发症.结论：逆行经硬性软性输尿管镜下钬激光一期治疗双侧上尿路结石碎石净石率高,并发症少,术后卧床及住院时间短,易于被患者接受,可作为治疗双侧上尿路结石的首选术式之一.Objective: To report the procedure of alternating use of retrograde rigid and flexible ureteroscopy combined with Holmium laser lithotripsy in one-stage treatment of calculi of bilateral urinary tract and to evaluate its efficiency and safety. Methods:145 patients of such kind underwent this treatment procedure from January, 2012 to May 2015. They were 25~61 years old(mean 46±9.7yrs). 71 patients complained of unilateral lumbar and abdominal pain. Gross or microscopic hematuria was their main complaints for 28 patients. 31 patients had history of recurrent urinary tract infections. 15 cases told incidental discovery of calculi. One side of ureteral stones and contralateral side of kidney stones occurred in 78 patients and 67 patients had bilateral kidney stones. 7Fr double J stent was placed in ureter one week before operation routinely. First was processed for ureteral stones for patients with ureteral and renal stones and for the smaller side of stone load for patients with bilateral kidney stones. Retrograde rigid ureteroscopic Holmium laser broke up ureteral calculi and flexible ureteroscopy was used to treat kidney calculi. The operative time of one stage was controlled within 120 minutes. Second-look lithotripsy was performed in patients with significant residual fragments. Stone clearance was defined as no fragments or a single fragment less than or equal to 4 mm in diameter on standard radiograph at 3-month follow-up.Results:All 145 patients underwent the operations safely and successfully, resulting in a 92.4%(134/145)stone-free rate. Only one patient need second- look lithotripsy through percutaneous nephrolithotomy because of large residual stone. All patients urined clear. 27 patients got fever 0-1 day postoperatively and the others had no complications. Conclusion:The patients with calculi of bilateral urinary tract can be treated safely and efficiently with one-stage retrograde rigid and flexible ureteroscopic techniques. Especially, this kind of technique need shorter bed and hospital stay and can

关 键 词：泌尿道 结石 双侧 一期 软性输尿管镜 硬性输尿管镜 钬激光 碎石术 

分 类 号：R699[医药卫生—泌尿科学]