物理振动排石辅助下输尿管软镜治疗复杂性输尿管上段结石  

Application of retrograde intrarenal surgery assisted by external physical vibration lithecbole for complex upper ureteral calculi

作　　者：张胜威[1] 赵兴华[1] 王友志[1] 许长宝[1] ZHANG Shengwei;ZHAO Xinghua;WANG Youzhi;XU Changbao(Department of Urology,The second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院泌尿外科,郑州450014

出　　处：《实用医学杂志》2018年第15期2537-2540,共4页The Journal of Practical Medicine

基　　金：河南省自然科学基金面上项目(编号:162300410295)

摘　　要：目的探讨物理振动排石辅助下输尿管软镜治疗复杂性输尿管上段结石的疗效。方法回顾性分析2015年6月至2017年12月采用输尿管软镜治疗的117例复杂性输尿管上段结石患者的临床资料,其中男73例、女44例;均为单侧输尿管结石,左侧58例,右侧59例;年龄(48.9±12.1)岁;结石最大直径(18.8±4.7)mm,结石CT值(887.5±321.9)Hu;肾积水程度(34.4±12.2)mm。给予行电子输尿管软镜碎石,术中使用套石篮将较大结石碎块取出。根据术后第1天腹部立位片或彩超复查情况,术后3 d酌情给予患者辅助行物理振动排石治疗。术后1个月复查KUB或彩超评估手术是否成功。结果 110例完成输尿管软镜手术,4例手术因软镜处理困难,改行开放处理,另外3例因肾盂尿液浑浊改行经皮肾镜手术。术后共有81(71.6%)例患者给予体外物理振动排石治疗,中位排石次数为1(0,2)次。中位手术时间45 min(36.5,55.0)min。1个月后复查,105例手术成功,成功率达89.7%。术后中位住院时间为3(3,3)d,均无严重并发症发生。结论物理振动排石辅助下输尿管软镜治疗复杂性输尿管上段结石成功率高,且安全、并发症少,可以作为复杂性输尿管上段结石的首选方案之一。Objective To evaluate the effectiveness of retrograde intrarenal surgery assisted by external physical vibration lithecbole for complex upper ureteral calculi.Methods The clinical data of 117 cases of complex upper ureteral calculi treated by retrograde intrarenal surgery combined with holmium laser in our hospital from June 2015 to December 2017 were retrospectively reviewed.There were 73 male cases,and 44 female cases.The average age was(48.9±12.1)years.The average maximal stone diameter was(18.8±4.7)mm.The average CT value of stone was(887.5±321.9)Hu.The average degree of hydronephrosis was(34.4±12.2)mm.All surgery were completed by electronic flexible ureteroscope,and the basket was used to remove the larger stone fragments during the operation.According to the examination of the first day after operation,whether use external physical vibration lithecbole was decided on the third day after operation.We evaluated the operation by KUB or ultrasound at 1 month later.Results 110 cases were completed by retrograde intrarenal surgery,and the procedure failed in 7 patients.External physical vibration lithecbole was conducted in 81(71.6%)cases.The median session of external physical vibration lithecbole was 1 time(ranging 0~2 time).The median operation time was 45 min(ranging 36.5~55.0 min).The total success rate was 89.7%(105/117)at 1 months later.The median hospital stay was 3 days(ranging 3-3 day).No major(Clavien grade 3 to 5)complications occurred.Conclusions Retrograde intrarenal surgery assisted by external physical vibration lithecbole is a safe and effective operation for complex upper ureteral calculi,and can be as a first line operation.

关 键 词：复杂性输尿管上段结石 输尿管软镜 物理振动排石 

分 类 号：R699.4[医药卫生—泌尿科学]