输尿管软镜下钬激光碎石术治疗直径≤20mm和>20mm上尿路结石的疗效比较  

Comparison in efficacy of flexible ureteroscopic holmium laser lithotripsy in treating upper urinary calculi ≤20mm and >20mm

作　　者：施华娟[1] 耿和[1] 吴宗林[1] 张涛[1] 刘翔[1] 唐炯[1] 朱洪炜[1] 

机构地区：[1]上海市普陀区人民医院泌尿外科,上海200060

出　　处：《现代泌尿外科杂志》2017年第2期123-127,共5页Journal of Modern Urology

基　　金：上海市卫生局青年科研项目(No.20114Y134)

摘　　要：目的评价输尿管软镜下钬激光碎石术治疗上尿路结石的疗效。方法回顾性分析2013年11月至2015年11月采用输尿管软镜下钬激光碎石术治疗125例上尿路结石患者的资料,结石最长径6~40(17.2±7.5)mm,其中小结石组(≤20mm)和大结石组(>20mm)患者分别为97例和28例,分别记录两组平均手术时间、术后住院天数、手术成功率、结石清除率(SFR)及术后并发症,并进行统计学分析,分析结石大小对治疗效果的影响。结果125例患者手术时间(73.3±34.5)min,术后住院时间(2.5±0.9)d。单次碎石术后SFR为89.6%。小结石组和大结石组手术时间分别为(63.7±28.5)min和(106.4±33.3)min,术后住院天数分别为(2.3±0.7)d和(3.4±1.3)d,差异均具有显著统计学意义(P<0.01),小结石组均优于大结石组。总并发症发生率为5.6%(7/125),小结石组术后尿脓毒血症1例,腰痛3例;大结石组术后发热1例,腰痛2例,均抗感染对症支持治疗后缓解,两组术后并发症比较差异无统计学意义(P>0.05)。术后2~4周复查腹部X线平片(KUB)或CT:小结石组5例结石残留,其中2例再次软镜碎石手术、1例体外冲击波碎石术、2例保守排石治疗;大结石组有6例结石残留,其中5例再次软镜下碎石、1例石街形成2周后行输尿管硬镜碎石术。一次碎石术后小结石组的结石消除率(SFR)(94.8%)明显高于大结石组(78.6%,P<0.05)。结论输尿管软镜下钬激光碎石术具有安全、高效、创伤小、并发症少、住院时间短的优势,是治疗上尿路结石安全可靠的方法,尤其适用于直径≤20mm上尿路结石患者。Objective To evaluate the efficacy and safety of flexible ureteroseopic holmium laser lithotripsy in treating up- per urinary calculi. Methods The clinical data of 125 patients with upper urinary calculi who underwent flexible ureteroscopic holmium laser lithotripsy during Nov. 2013 and Nov. 2015 were retrospectively reviewed. The longest diameter of stone was 6 -40 （17.2±7.5） mm. Of all cases, 97 had small stones （420 mm） and 28 had large stones （〉20 mm）. The operation time, postoperative hospital stay, stone free rate （SFR） and complications were compared between the two groups. Results The mean operation time and postoperative hospital stay were （73.3±34.5） rain and （2.5±0.9） d. The SFR after a single procer dure was 89.6% （112/125）. The operation time was （63.7±28.5） rain vs. （106.4±33.3） min for the small stone and large stone group （P〈0.01）, and postoperative hospitalization time was （2.3±0.7） d vs. （3.3±2.1） days, （P〈0.01）. The total complication rate was 5.6 % （7/125）. In the small stone group, 4 cases developed complications （1 urine sepsis and 3 lumbago）, while in the large stone group, 3 cases developed complications （1 fever and 2 lumbago）, （P〉0.05）. A follow-up KUB or renal CT scan 2-4 weeks after the procedure showed that in the small stone group, 5 cases had residual calculi, of which 2 underwent flexible ureteroscopic lithotripsy again, 1 received ESWL, and 2 received conservative trcatment; in the large stone group, 6 cases had residual calculi, of which 5 underwent flexible ureteroscopic lithotripsy again, and 1 received rigid ureteroscopie holmium laser lithotripsy two weeks after the stone street was formed. The SFR of the small stone group was 94.80%, which was higher than that of large stone group （78.6%, P〈0.05）. Conclusions Flexible ureteroscopic holmium laser litho- tripsy is a safe, effective management for upper urinary calculi, with minimal injuries, high stone free rates and fewer complications, e

关 键 词：肾结石 输尿管结石 输尿管软镜 钬激光 碎石术 

分 类 号：R693.4[医药卫生—泌尿科学]