输尿管软镜钬激光碎石术治疗孤立肾肾结石43例临床分析  

Flexible ureteroscopic holmium laser lithotripsy in the treatment of calculi of solitary kidney:a report of 43 cases

作　　者：李权[1] 李涛[1] 刘建河[1] 

机构地区：[1]上海交通大学医学院附属新华医院泌尿外科,上海200092

出　　处：《现代泌尿外科杂志》2016年第12期925-928,共4页Journal of Modern Urology

摘　　要：目的 探讨输尿管软镜钬激光碎石术治疗孤立肾肾结石的安全性和有效性。方法 回顾分析我科2012年9月至2015年12月采用输尿管软镜钬激光碎石术治疗孤立肾肾结石43例临床资料。评估分析患者的手术时间、手术次数、术后住院时间、结石清除率、并发症率以及肾功能变化。结果 一次成功进镜率97.7%（42/43）,平均手术时间76.5±21.1（40~135）min,术后平均住院时间3.6±0.8（2~6）d。结石负荷〈20 mm和≥20 mm两组,平均手术次数分别为1.1（1~2）和1.6（1~3）次（P=0.007）;两组术后1月结石清除率分别为85.7%和60.0%（P=0.073）;两组最终结石清除率分别为96.4%和86.7%（P=0.275）。术后1月复查肾功能无明显变化。术后并发症率为20.9%,无严重并发症发生。结论 输尿管软镜联合钬激光碎石可安全、有效地治疗孤立肾肾结石,结石负荷≥20mm的患者通过分期手术也可取得较高的结石清除率。ObjectiveTo evaluate the safety and efficacy of flexible ureteroscopy combined with holmium laser in the treatment of calculi of solitary kidney. MethodsClinical data of 43 cases of solitary renal calculi treated with flexible ureteroscopic holmium laser lithotripsy during Sep. 2012 and Dec. 2015 were retrospectively analyzed. Operation time，number of operations，postoperative hospital stay，stone-free rate，complication rate and changes in renal function were reviewed. ResultsOf all 43 cases，42 （97.7%） operations were successful with one session. The average operation time was 76.5±21.1 （40-135） min. The mean postoperative hospital stay was 3.6±0.8（2-6） days. The average number of procedures needed for patients with stones ＜20 mm and ≥20 mm in diameters were 1.1 （1-2） and 1.6（1-3） times，respectively （P=0.007）; the initial stone-free rate （after 1 month） was 85.7 vs. 60.0%，（P=0.073）; the final stone-free rate was 96.4%vs. 86.7%，（P=0.275）. No significant change of renal function was observed 1 month after operation. The overall complication rate was 20.9%，and no serious complications occurred. ConclusionsFlexible ureteroscopic holmium laser lithotripsy is a safe and effective treatment for solitary renal calculi. Patients with renal stones≥20 mm in diameter can achieve a high stone-free rate by staging surgery.

关 键 词：输尿管软镜 孤立肾 肾结石 结石清除率 

分 类 号：R692.4[医药卫生—泌尿科学]