持续肾盂冲洗辅助输尿管软镜治疗大负荷上尿路结石经验总结  

Clinical observation of high-load upper urinary tract calculi treated with continuous irrigation of renal pelvis after flexible ureteroscopy

作　　者：张倩[1] 张晓波[1] 匡雪春[1] 戴元清[1] 

机构地区：[1]中南大学湘雅医院老年医学外科,湖南长沙410008

出　　处：《中国医学工程》2017年第7期23-26,共4页China Medical Engineering

摘　　要：目的探讨输尿管软镜术后持续肾盂冲洗辅助治疗大负荷结石的安全性与可行性。方法 41例肾和输尿管上段结石患者采用输尿管软镜碎石取石术后联合肾盂持续冲洗辅助治疗。采用粉末化为主,块样化相结合的碎石方式,尽量把结石粉末化至2 mm以下,持续冲洗均采取袋装生理盐水冲洗,速度保持在40~80滴/min,冲洗时间为48 h。停止冲洗完毕观察6 h,复查腹部平片(KUB)后拔出输尿管导管及导尿管。结果持续冲洗肾盂压为24~39 cm H_2O,持续冲洗通畅,无脓毒血症等发生。术后2~4周行KUB或泌尿系CT(平扫+三维)检查。一期总的结石清除率为75.6%(31/41)。其中结石大小2.0~2.5 cm组30例中,一期结石清除率83.3%(25/30);2.5~3.0 cm组7例一期结石清除率57.1%(4/7);3.0~4.0 cm组4例一期结石清除率50%(2/4)。结论在输尿管软镜术后肾盂持续冲洗辅助治疗安全可行,可预防石街形成,减少术后尿脓毒症发生,提高结石清除率,有较好的临床推广应用价值。【Objective】To investigate the safety and feasibility of continuous irrigation of renal pelvis after flexible ureteroscopy.【Methods】Forty-one cases of renal and upper ureteral calculi were treated with flexible ureteroscopy combined with continuous irrigation of renal pelvis. Stones were pulverized into particles less than 2 mm, continuous irrigation with saline bags was taken, irrigation rate remained at 40～80 drops/min, and the washing time was 48 h. Six-hour observation was taken after stop washing, and plain film of kidney, ureters, bladder（KUB） was performed after the removal of ureteral catheter and urethral catheter.【Results】Renal pelvic pressure during continuous irrigation was 24～39 cm H_2O. Continuous washing was unobstructed, and no sepsis etc. Two to four weeks after surgery, KUB or CT（nonenhanced ＋ three-dimensional） examination was performed. The total stone clearance rate was 75.6%（31/41）. Among the 30 cases of stone size 2.0～2.5 cm group, one-stage stone clearance rate was 83.3%（25/30）, which was 57.1%（4/7） in 2.5～3.0 cm group, and 50%（2/4） in 3.0～4.0 cm group.【Conclusion】Adjuvant therapy of continuous irrigation of renal pelvis after flexible ureteroscopy for high-load upper urinary tract calculi is safe and feasible. It can prevent stone formation, reduce the incidence of urinary sepsis after operation, and improve the stone clearance rate, having good clinical application value.

关 键 词：上尿路结石 治疗 输尿管软镜术 肾盂冲洗 

分 类 号：R699[医药卫生—泌尿科学]