输尿管软镜结合体外冲击波碎石治疗孤立肾上尿路结石疗效分析  

作　　者：杜春明 施东辉[1] 何兆飞[1] 杨祖佑[1] 张君俊[1] 

机构地区：[1]江苏省苏州市吴中人民医院,215000

出　　处：《浙江临床医学》2019年第7期928-930,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨输尿管软镜碎石取石术(RIRS)结合体外冲击波碎石(ESWL)治疗孤立肾上尿路结石的安全性和有效性。方法回顾性分析2013年2月至2018年3月RIRS结合ESWL治疗的42例孤立肾上尿路结石患者的临床资料。其中Ⅰ期所有患者均接受RIRS治疗,术后1个月进行腹部X线平片、B超或CT检查。分析术后1个月I期结石清除率及并发症发生情况。若位于肾下盏或结石移位至肾下盏,且输尿管软镜不能探及进行腔内碎石的结石患者,Ⅱ期行ESWL治疗。残余结石≥4mm为有临床意义的结石残余。结果42例均顺利进镜并完成秋激光碎石术。所有患者均无尿源性脓毒血症、输尿管穿孔、输尿管撕脱及出血等严重并发症,Ⅰ期碎石成功率达78.6%(33例)。术后3例出现畏寒发热,经抗感染治疗后痊愈。4例出现不同程度肉眼血尿,经治疗2~4d后消失。术后1个月复查,9例术前肾功能不全患者中有4例肾功能恢复正常,剩余5例血肌肝有不同程度下降。9例残余结石>4mm进行Ⅱ期ESWL处理,其中6例碎石后1个月复查结石排尽或<2mm,3例再次行ESWL,1例结石排尽,2例残石直径仍有4mm,总体结石清除率达95.2%。结论对于孤立肾上尿路结石,RIRS是一种可选的可靠和有效的手术方式,结石清除率较高,分期结合ESWL有利于提高输尿管软镜碎石后残余结石的清除率。Objective To evaluate the safety and efficacy of retrograde intrarenal surgery ( RIRS ) combined with extracorporeal shockwave lithotripsy in the treatment of upper urinary tract calculi of solitary kidney. Methods From February 2013 to March 2018, 42 cases of upper urinary tract calculi of solitary kidney were treated by RIRS combined with ESWL.The stone free rate and complication rate of operation ( 1 month after ) were recorded and concluded.The total 42 patients underwent one-stage RIRS, B-ultrasonography, KUB or CT were performed to evaluate the stone free rate one month after the operation.If the flexible ureteroscope could not locate the lower calyx calculi or the stones drifting into lower calyx, second-stage ESWL was performed.Residual stones M 4mm were considered as clinical significance of residual stone. Results The retrograde intrarenal surgery was successfully completed in all the 42 patients. The total stone free rate was 78.6%( 33/42 ). No severe complications such as urosepsis, ureteral perforation, ureteral avulsion or transfusion occurred. Three patients got chills and fever after operations who were cured by after anti-infection treatment. Four patients got gross hematuria after operation, which were disappered from two days to four days. Among nine patients with preoperative renal insufficiency, renal function of four patients were restored to normal at postoperative 1-month follow-up, the rest five patients had different degrees of decline of serum creatinine. Nine cases of residual stones (diameterM4mm ) received ESWL. Among them, six cases had no residual stones or residual stones with diameter smaller than 2mm. The rest three cases received ESWL again two weeks later, one case had no residual stone, and two cases still had residual stone with the diameter of 4mm. The total stone clearance rate was 95.2%. Conclusion RIRS is a safe and effective procedure for treating upper urinary tract calculi in patients with solitary kidney, and especially combined with ESWL, which can also improve the

关 键 词：输尿管软镜 孤立肾 上尿路结石 体外冲击波碎石术 残余结石 

分 类 号：R691.4[医药卫生—泌尿科学]