组合式输尿管软镜治疗泌尿系上尿路结石358例效果分析  

Modular flexible ureteroscope for the treatment of upper urinary calculi:a report of 358 cases

作　　者：张艳平[1] 刘凯隆[1] 路保赛[1] 齐进春[1] 国平英[1] 黎玮[1] 

机构地区：[1]河北医科大学第二医院泌尿外科,河北石家庄050000

出　　处：《河北医科大学学报》2016年第10期1131-1134,1138,共5页Journal of Hebei Medical University

摘　　要：目的 探讨组合式输尿管软镜治疗上尿路结石的临床效果和安全性。方法 输尿管上段及肾结石患者358例应用组合式输尿管软镜联合钬激光碎石术。输尿管结石125例,结石大小13～23mm,平均（17.3±1.3）mm。肾结石233例,其中肾盂结石105例,上、中盏结石63例,下盏结石65例;结石大小14～39mm,其中结石〈20mm 146例,结石大小14～19 mm,平均（16.5±1.4）mm,≥20 mm 87例,结石大小20～39 mm,平均（24.3±6.5）mm。观察结石清石率、手术时间及并发症。结果 输尿管上段结石组及肾结石组的一次进镜成功率差异无统计学意义,输尿管结石组碎石、清石率高于肾结石组,而手术时间短于肾结石组。按结石大小分组,其中〈20mm肾结石组清石率高于≥20mm肾结石组,而手术时间短于≥20mm肾结石组。按结石部位分组,不同部位的肾结石亚组一次进镜率、碎石和清石成功率、手术时间差异均无统计学意义。2组术后并发症为ClavienⅠ或Ⅱ级,10例术后出现发热、寒战,3例出现血压低等休克表现,经治疗后好转,2组并发症发生率差异无统计学意义。结论输尿管软镜结合钬激光治疗输尿管上段结石及肾结石安全、有效,可作为上尿路结石的首选治疗方式。Objective To evaluate the safety and clinical value of modular flexible ureteroscope combined with holmium laser for the treatment of upper urinary calculi. Methods Three hundred and fifty-eight patients with upper urinary calculi were treated by modular flexible ureteroscope combined with holmium laser,including 125 cases of upper ureteral calculi with a mean diameter of range 13--23 mm, average （17.3±1.3） mm, 105 cases of renal pelvis calculi, 63 cases of calculi in upper and middle calyx and 65 cases of lower calyx calculi. Two hundred and thirty-three cases with diameter range 14--39mm were classified into patients with the diameter〈20 mm（n=146）, with a mean diameter of range 14--19 mm, average（16.5±1. 4） mm,and patients with the diameter20 mm（n =87）, a mean diameter of range 20--39 mm, average（24.3±6.5） mm. Demographic data, operative duration, complication rate, and stone- free rate were recorded. Results Lithotripsy was performed successfully in patients with the upper ureteral calculi and those with renal calculi. Stone clearance rate in upper ureteral calculi group were higher than that in renal calculi group, but with shorter operating time. And stone clearance rate in the cases with the stones diameter〈20 mm were higher than that in the cases with the stones diameter ≥20 mm. According to the position of the stone, there was no significant difference in the rate of success rate, the time of operation, the success rate and the operation time of the sub groups of different parts of the kidney Stones, There were no sewere complications, exeept Clavien grade Ⅰ or Ⅱ. Ten patients had postoperative high fever and： ehills. Three patients who had Shock symptoms such as hypotension were cured by anti-infective and anti-shock therapy.There was no significant difference between the two groups. Conelusion Modular flexible ureteroscope combined with holmium laser is an established minimal invasive treatment for the upper urinary calculi with a high success rate and low morbidity. M

关 键 词：上尿路结石 输尿管镜 激光 

分 类 号：R691.4[医药卫生—泌尿科学]