输尿管软镜治疗孤立肾鹿角状结石的疗效分析  

Safety and efficacy of retrograde intrarenal surgery for staghorn calculi in patients with solitary kidney

作　　者：赖德辉[1,2] 李名钊[3] 盛明[1,2] 李逊[1,2] 何永忠[1,2] 李天[1,2] 徐桂彬[1,2] 杨炜青[1,2] 

机构地区：[1]广州医科大学附属第五医院泌尿外科,510700 [2]广州医科大学微创新技术和产品转化中心,510700 [3]中山大学附属第三医院泌尿外科,广州510630

出　　处：《中华腔镜泌尿外科杂志（电子版）》2016年第5期25-28,共4页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的探讨输尿管软镜碎石取石术（RIRS）治疗孤立肾鹿角状结石的安全性和有效性。方法回顾性分析2014年10月至2015年10月广州医科大学附属第五医院用RIRS治疗30例孤立肾鹿角状结石患者的临床资料，分析术后1个月结石清除率及并发症情况。残留结石则采取再次RIRS、体外冲击波碎石或经皮肾镜碎石取石术（PCNL）。结果平均结石负荷：（628±27）mm^2。其中16例（53．3％）行一期RIRS，12例（40％）需行二期RIRS，2例（6．7％）二期行PCNL。平均手术时间（84±21）min。术后住院时间4～14d，中位数6d。术后1个月一期结石清除率53-3％（16／30），总结石清除率86．7％（26／30）。1例术后因输尿管石街出现感染性休克和急性肾功能衰竭，1例术后肾周尿源性脓肿，均治愈。术后发热5例。无输血、输尿管穿孔、撕脱等并发症。总并发症发生率23．3％（7，30）。结论对于孤立肾鹿角状结石，RIRS是一种可选的可靠和有效的手术方式。分期结合PCNL有利于提高结石清除率和安全性。Objective To evaluate the safety and efficacy of retrograde intrarenal surgery （RIRS） in the treatment for staghorn calculi in solitary kidney. Methods From October 2014 to October 2015, 30 cases of staghom calculi in solitary kidney were treated by RIRS. Stones were fragmented by holmium laser. The stone free rate and the complication rate were recorded. Residual stones were re-treated with a secondary RIRS, ESWL or PCNL. Results Mean stone burden was （628 ±27） mm^2. Of 30 patients, 16 patients underwent one-stage RIRS, 12 underwent two-stage RIRS and 2 underwent PCNL. The average operation time was （84±21） rain. The median postoperative stay was 6 days （range 4-14 d）. The one-month stone free rate was 53.3% （16/30）. The total stone free rate was 86.7% （26/30） after staged procedure. One case experienced infectious shock and acute renal failure due to ureteral stone street, one case developed perirenal urinous abscess. Postoperative fever occurred in 5 cases after RIRS. No blood transfusion, ureteral perforation or ureteral avulsion occurred. The total complication rate was 23.3% （7/30）. Conclusions RLRS is a safe and effective procedure for treating staghorn calculi in patients with solitary kidney. Staged RIRS and combined with mPCNL should he recommended, when the stone burden is large.

关 键 词：孤立肾 鹿角状结石 输尿管镜 

分 类 号：R699.2[医药卫生—泌尿科学]