输尿管软镜联合吸引鞘钬激光碎石术治疗6例直径2 cm以上肾结石报告  

A preliminary report of flexible ureteroscopy combined with sucking-sheath and holmium laser in the treatment of renal stones>2 cm

作　　者：施靖宇 方立 谢国海[2] 张东旭[2] 刘万樟 黄挺 程跃[2] SHI Jingyu;FANG Li;XIE Guohai;ZHANG Dongxu;LIU Wanzhang;HUANG Ting;CHENG Yue(Department of Surgery,Medical School of Ningbo University,Ningbo 315211;Department of Urology,The First Hospital of Ningbo,Ningbo 315010,China)

机构地区：[1]宁波大学医学院外科学,浙江宁波315211 [2]宁波市第一医院泌尿外科,浙江宁波315010

出　　处：《现代泌尿外科杂志》2021年第4期301-304,332,共5页Journal of Modern Urology

基　　金：浙江省医药卫生科技面上基金(No.2019326541)。

摘　　要：目的观察输尿管软镜联合吸引鞘,使用“摩西”钬激光治疗直径>2 cm肾结石的有效性和安全性。方法2019年1~3月对6例肾结石>2 cm的患者行输尿管软镜联合吸引鞘“摩西”钬激光碎石术,其中左肾结石2例,右肾结石4例;结石直径3.0~8.2 cm,平均(4.4±1.8)cm;平均CT值(790±173)Hu。术中使用一次性输尿管导引鞘Ⅱ型(吸引型鞘,简称吸引鞘),采用200μm“摩西”钬激光碎石,碎石单发能量0.5~1.0 J,碎石频率50~70 Hz,“雾霾化”碎石(即结石碎片<1 mm),同时利用吸引通道吸出冲洗液及结石,吸引压力0.04 MP。结果手术时间66~170 min,平均(129.9±30.9)min。一期碎石术后复查腹平片(KUB)和计算机断层扫描(CT),4例未见>4 mm阳性结石残留,一期结石清除率66.7%。2例结石残留患者行二期软镜联合吸引鞘手术,1例未见阳性结石残留,1例肾下盏结石残留,二期结石清除率83.3%。1例患者术后发热超过38℃,对症处理后好转。结论输尿管软镜联合吸引鞘,采用“摩西”钬激光“雾霾化”碎石技术治疗直径>2 cm的以单发为主的肾结石是可行的。Objective To observe the efficacy and safety of flexible ureteroscopy combined with sucking-sheath and“Moses”holmium laser in the treatment of renal stones>2 cm.Methods From Jan.to Mar.2019,6 patients with renal stones>2 cm were treated,including left kidney stones in 2 cases and right kidney stones in 4 cases.The stones ranged from 3.0-8.2 cm in size,average(4.4±1.8)cm.The average CT value was(790±173)Hu.During operation,disposable sucking-sheath was used,the holmium laser was 200μm,single shot power was 0.5-1.0 J,and frequency was 50-70 Hz.The stones were crushed into fragments<1 mm.At the same time,a suction channel was used to suck out the irrigation liquid and stones with the suction pressure of 0.04 MP.Results The operation time was 66-170 min,average(129.9±30.9)min.After the first-stage operation,KUB and CT observed no residual stones>4 mm in 4 cases.The stone-free rate(SFR)was 66.7%.After the second-stage operation was performed in the 2 cases with residual stones,one patient had no residual stones,and the other had residual stones in the lower calyx.The SFR of the second-stage surgery was 83.3%.Fever higher than 38℃was observed in 1 patient,who recovered after symptomatic treatment.Conclusion Flexible ureteroscopy combined with sucking-sheath and“Moses”holmium laser is feasible in treating single renal stones>2 cm.

关 键 词：输尿管软镜 摩西 钬激光 吸引鞘 肾结石 

分 类 号：R691.4[医药卫生—泌尿科学]