输尿管软镜联合钬激光在直径>2cm肾结石的临床应用  

Flexible Ureteroscopy Combined with Holmium Laser Lithotripsy for Renal Stones of Longer than 2 cm in Diameter

作　　者：骆华[1] 王小波[1] 廖高源 刘琛[1] 王春霞[1] 刘伦波[1] 

机构地区：[1]德阳市第二人民医院泌尿外科,四川德阳618000

出　　处：《华西医学》2016年第3期495-498,共4页West China Medical Journal

基　　金：德阳市科技局科技支撑计划(2014SZ039)~~

摘　　要：目的探讨输尿管软镜对直径〉2 cm肾结石处理的安全性、有效性及临床应用价值。方法回顾性分析2012年8月-2014年7月,采用输尿管软镜联合钬激光碎石术处理经选择直径〉2 cm的肾结石15例。术前留置输尿管支架管1~2周,术中使用F8.0/9.8输尿管硬镜探查、扩张患侧输尿管,置入超滑导丝后留置输尿管软镜鞘,引入输尿管软镜进行钬激光碎石,较大、影响视野的结石碎片用套石网篮取出。结果一次性进镜成功率100%,无患者因发生术中严重并发症而停止手术。手术时间50~125 min,平均75 min。无输尿管穿孔、脓肾及急性肾功能不全等并发症发生。术后4例出现高热,经积极抗感染治疗后好转。术后2 d复查腹部X线平片结石清除率73.3%（11/15）;术后4周随访,结石清除率86.7%（13/15）;1例少量残留结石碎片停留于输尿管中下段,予以输尿管硬镜碎石后排出;1例肾脏残余结石二期输尿管软镜下钬激光碎石。结论经输尿管软镜碎石术治疗经选择的直径〉2 cm肾结石是安全、有效的,可以作为有效方法进行推广使用。Objective To evaluate the safety and efficacy of flexible ureteroscopic lithotripsy for renal stones of longer than 2 cm in diameter. Methods From August 2012 to July 2014, 15 selected patients with renal calculi of longer than 2 cm in diameter underwent flexible ureteroscopic lithotripsy with holmium laser by the same surgeon. Preoperative indwelling ureteral stent was performed for 1-2 weeks, and super smooth guidewire was inserted after checking and dilation of the ureter was performed with F8.0/9.8 rigid ureterosope. Flexible ureteroscope sheath was inserted through guidewire. Ureterosope was followed by flexible ureteroscope sheath. Larger stone fragments were removed by basket. Results The success rate of ureteroscopic insertion was 100% and no severe intraoperative complications occurred. The operation time ranged from 50 to 125 minutes averaging 75. No ureteral perforations or pyonephrosis or acute renal insufficiency occurred. Four patients had high fever after operation and improved after positive anti-infection treatment. After 2 days, the stone-free rate was 73.3% （11/15） by reviewing KUB. The follow-up of 4 weeks showed the stone-free rate was 86.7% （13/15）. One case of stone fragments retained in the middle and lower ureter and the fragments were taken out by ureteroscopic lithotripsy. The other case of renal residual calculi was operated by flexible ureteroscope holmium laser lithotripsy in two stage. Condusion Flexible ureteroscopic lithotripsy is a favorable option for patients with renal stones of longer than 2 cm in diameter, especially for recurrent renal calculi.

关 键 词：肾结石 输尿管软镜 钬激光 

分 类 号：R699[医药卫生—泌尿科学]