输尿管软镜技术在治疗肾下盏结石中的临床运用与选择  

Application and selection of flexible ureteroscopy in treatment of subrenal calyx calculi

作　　者：陈绪龙[1] 石家齐[1] 陈方敏[1] 李登宝[1] 姜锡男[1] 

机构地区：[1]贵州医科大学附属医院泌尿外科,贵州贵阳550001

出　　处：《兰州大学学报（医学版）》2015年第6期68-72,共5页Journal of Lanzhou University（Medical Sciences）

摘　　要：目的输尿管软镜技术治疗肾下盏结石的体会以及应用选择。方法收集行逆行输尿管软镜钬激光碎石术治疗肾下盏结石患者88例,根据Ⅰ期碎石成功与否分为碎石成功组和碎石失败组。碎石成功组共71例,术后1月复查腹部平片无残留结石,或者结石碎片〈0.3 cm且无临床症状。碎石失败组共17例,术中未能有效碎石或未能找到结石。结合2组病例术前留置双J管情况、手术干预史、肾内集合系统解剖特点及结石情况等,对碎石成功与失败原因进行总结与分析,探讨输尿管软镜技术在治疗肾下盏结石中的运用及选择。结果碎石成功组术前2周留置双J管61例;结石直径0.8～2.0 cm,平均1.2 cm;结石所在肾盂肾下盏夹角为35°～60°,平均40°。碎石失败组术前留置双J管6例;结石直径1.5～3.0 cm,平均2.5 cm;结石所在肾盂肾下盏夹角为20°～35°,平均27°。Ⅰ期碎石失败的原因包括单纯结石因素6例、肾脏集合系统解剖因素6例、输尿管因素4例和手术操作因素1例。结论输尿管软镜治疗肾下盏结石是一种安全、有效的微创方法,但并不适用于所有的肾下盏结石治疗,对于结石直径〉2 cm、肾盂输尿管夹角〈35°、术前曾有输尿管手术干预史的病人,应谨慎选用输尿管软镜或选择其他手术方式。Objective To summarize the application and selection of flexible ureteroscopy in the treatment of subrenal calyx calculus. Methods A total of 88 patients underwent retrograde flexible ureteroscopic procedures for the subrenal calyx calculus. All cases were divided into two groups according to the success or failure of holmium laser lithotripsy for the first time： group A with successful lithotripsy, a total of 71 cases, there were no residual stones or stone fragments 〈 0.3 cm under abdominal X-ray 1 month after lithotripsy without clinical symptoms. Group B with failed lithotripsy, a total of 17 cases, no effective lithotripsy and or failed to find stones during operation. Considering with the preoperative indwelling double J stent, surgical intervention, the anatomical features and stone within the kidney collecting system according to the two groups patients, the reasons for the success and failure of the lithotripsy were summarized and analyzed. Results 61 patients from group A were with indwelling double J stent in ureter （85.9%） before operation. The stone diameter was from 0.8 cm to 2.0 cm with average of 1.2 cm, the Infundibulopelvic angle where calculus located ranged from 35° to 60° with average of 40°. 6 patients were with indwelling double J stent in ureter （38.3%） from group B, stone diameter was from 1.5 cm to 3.0 cm with an average of 2.5 cm, infundibulopelvic angle where calculus located ranged from 20° and 35° with average of 27°. The causes of lithotripsy failure for the first phase included stones themselves （6 cases）, renal collection system （6 cases）, ureter （4 cases） and surgical operating （1 case ）. Conclusion Flexible ureteroscopy in treating subrenal calyceal calculies is a safe, effective and minimally traumatic technique, but it does not apply to all of the renal calyx calculi. Patients with stone diameter 〉 2 cm, angle of renal pelvis and ureter 〈 35° and operation history should be chosen carefully when using flexible ureteroscopy lithotripsy or

关 键 词：输尿管软镜 肾下盏结石 肾盂肾下盏夹角 

分 类 号：R693.4[医药卫生—泌尿科学]