输尿管镜碎石术治疗肾和输尿管结石2150例的并发症分析  

Analysis of the complications of 2150 cases of renal and ureteral calculi treated by ureteroscopic lithotripsy

作　　者：龙清志[1] 李翔[1] 贺大林[1] 陈兴发[1] 王新阳[1] 樊荣[1] 张露[1] 何辉[1] 

机构地区：[1]西安交通大学第一附属医院泌尿外科,陕西西安710061

出　　处：《现代泌尿外科杂志》2016年第8期606-609,共4页Journal of Modern Urology

摘　　要：目的对2 150例肾和输尿管结石患者行输尿管镜碎石术,总结分析术中及术后并发症。方法 2006年1月到2015年6月,对我院连续收住的2 150例肾和输尿管结石患者,术前采用B超、尿路平片、静脉尿路造影、CT、肾小球滤过率(GFR)等检查评估结石及肾脏情况。采用Olympus输尿管硬镜或软镜,对所有患者均行输尿管镜碎石术(URS),记录患者术中术后并发症、处理方法和产生原因。结果定义结石碎片<4mm为结石清除。在2 150例上尿路结石患者中,一次治疗结石清除1 881例(87.5%),结石残留269例(12.5%)。术中并发症包括手术失败28例,结石退回肾脏97例,输尿管穿孔20例,出血48例,输尿管黏膜部分剥脱1例,无输尿管撕脱。术后近期并发症:尿路感染38例,3例尿脓毒血症,肾包膜下血肿2例,持续性肉眼血尿22例(肉眼血尿时间超过3d),双J管回缩2例,脱出1例。术后远期并发症:输尿管梗阻27例,输尿管狭窄7例。引起并发症的原因多样,所有并发症均进行相应处理。结论输尿管镜碎石术治疗肾和输尿管结石效果肯定。但该手术存在一定的术中术后并发症,认识和掌握这些并发症有助于指导泌尿外科医生尽可能安全实施这种治疗方式。Objective To summarize and analyze the complications of renal or ureteral calculi treated by ureteroscopic lithotripsy. Methods Clinical data of 2 150 cases of simultaneous renal and ureteral calculi treated during Jan. 2006 and June 2015 were retrospectively analyzed. All patients received ultrasound of stone and kidney, KUB, intravenous urography, CT and renal GFR. All patients underwent ureteroscopic lithotripsy with Olympus＇s flexible ureterorenoscopy or semirigid ureteros- copy. Demographic data and perioperative complications were recorded. Results Stone-free was defined as fragments were less than 4 ram. Of all patients, 1 881（87.5~） achieved stone-free with one procedure, and 269 （12.5%） had residual stones. Intraoperative complications included surgical failure in 28 cases, stone migration to kidney in 97 cases, ureter perforation in 20 cases, bleeding in 48 cases, and ureter mucosa partial stripping in 1 case. No ureter avulsion was observed. Early postoperative complications were urinary tract infection in 38 cases, sepsis in 3 cases, kidney hematoma in 2 cases, persistent hematuria （ex- isting more than 3 days） in 22 cases, double-J retraction in 2 cases, and double-J falling in 1 case. Late postoperative complica- tions were ureter obstruction in 27 cases and ureter stricture in 7 cases. The causes of complications were varied. All complica- tions were treated with auxiliary methods. Conclusions The treatment of renal and ureteral calculi by URS is effective. However, some intraoperative and postoperative complications occur during this procedure. It is helpful to decrease the inci- dence of complications if urologists recognize and understand those complications.

关 键 词：肾结石 输尿管结石 输尿管镜碎石术 并发症 

分 类 号：R692.4[医药卫生—泌尿科学]