输尿管软镜下钬激光碎石术治疗直径2cm以上肾结石疗效观察  

Curative Effect of Holmium Laser Lithotripsy through Flexible Ureteroscope for Renal Calculi of over 2 cm in Diameter

作　　者：王亮[1] 刘吉文[1] 刁思军 黄一珂[1] 杨航[1] 刘祥丹[1] 曹文峰[1] 李沙丹[1] 陈卫国[1] 李晓伟[1] 杨伟[1] 周婷婷[1] 

机构地区：[1]成都军区总医院泌尿外科,成都610083

出　　处：《华西医学》2016年第11期1814-1817,共4页West China Medical Journal

摘　　要：目的 探讨输尿管软镜下钬激光碎石术治疗直径 2 cm 以上肾结石的安全性和有效性。方法 回顾性分析 2012 年 12 月－ 2015 年 3 月采用逆行输尿管软镜钬激光碎石术治疗 37 例直径＞ 2 cm 肾结石患者的临床资料。本组结石直径 2.0 ～ 3.5 cm,单发结石 22 例,多发性结石 15 例。术前患侧留置输尿管支架管 1 ～ 2周,术中用 F8.0/9.8 输尿管硬镜置入导丝后留置输尿管软镜鞘,引入输尿管软镜,钬激光碎石,钬激光功率≤ 30 W（1.0 ～ 1.5 J/15 ～ 20 Hz）。结果 全部患者一次进镜成功,手术时间 40 ～ 185 min,平均 73 min。术后 1 例出现脓毒血症,经积极抗感染等治疗后治愈,余无严重并发症。术后 4、8 周随访,结石清除率分别为 73.0%（27/37）、86.5%（32/37）。结论 输尿管软镜碎石术治疗直径＞ 2 cm 肾结石,具有创伤小、并发症少、恢复快、结石清除率较高等优点,可选择性用于体积＞ 2 cm 的肾结石治疗。Objective To evaluate the safety and efficacy of flexible ureteroscopic lithotripsy for patients with renal calculi of more than 2 cm in diameter. Methods the Clinical data of 37 patients with renal calculi of more than 2 cm in diameter treated with holmium laser lithotripsy through flexible ureteroscope between December 2012 and March 2015 were retrospectively analyzed. In this group, stone diameter was between 2.0 cm and 3.5 cm, including 22 cases of single stone and 15 cases of multiple stones. Preoperative ureteral stents were indwelt in all the patients for 1-2 weeks. After dilation of the ureter with F8/9.8 rigid ureteroscope, the ureteral access sheath for flexible ureteroscope was inserted to the target ureter followed by flexible ureteroscope. Stones were fragmentized by holmium laser and the power was not more than 30 W （1.0-1.5 J/15-20 Hz）. Results The success rate of ureteroscopic insertion was 100% （37/37）. The operation time ranged from 40 to 185 minutes with a mean of 73 minutes. After the operation, one patient had sepsis, and was cured after positive anti-infection treatment. No other serious complications occurred. Four and 8 weeks after surgery, the free-stone rate was 73.0% （27/37） and 86.5% （32/37） respectively. Conclusions The flexible ureteroscopic lithotripsy is advantageous in less trauma, fewer complications, quick recovery and higher free-stone rate. It can be used to treat renal calculi of over 2 cm in diameter selectively.

关 键 词：肾结石 输尿管软镜 钬激光 

分 类 号：R699.2[医药卫生—泌尿科学]