输尿管软镜碎石术后输尿管石街46例治疗体会  

Treatment of ureteral stone street with flexible ureteroscopic lithotripsy:a report of 46 cases

作　　者：黄翻 白大应 刘杰[1] 严映敏 李柱仕 张忠军 赵虎 HUANG Fan;BAI Daying;LIU Jie;YAN Yingmin;LI Zhushi;ZHANG Zhongjun;ZHAO Hu(Department of Urology,Ziyang People's Hospital,Ziyang 641300,China)

机构地区：[1]资阳市人民医院泌尿外科,四川资阳641300

出　　处：《现代泌尿外科杂志》2022年第2期130-132,共3页Journal of Modern Urology

基　　金：四川省卫生健康委员会基金(No.19PJ306)。

摘　　要：目的探讨大于2 cm输尿管上段结石和肾结石经输尿管软镜碎石术(FURL)后输尿管石街的发生率,以及采用微创手术方式的治疗效果。方法回顾性分析资阳市人民医院2018年1月-2020年12月通过FURL治疗的直径大于2 cm的肾及输尿管上段结石423例,术后1 d-2周内行腹部平片发现输尿管石街者46例,输尿管石街长1.0-7.5 cm,对其运用Coptcoat法进行分型,其中Ⅰ、Ⅱ、Ⅲ型石街分别为16、10、20例。所有患者术后采用保守药物排石4-8周,石街仍不能排出者,均通过输尿管软镜钬激光碎石取石(URL)治疗。结果423例结石行FURL术后有46(10.9%)例患者发生输尿管石街,药物排石4周后,仅16例(Ⅰ型14例,Ⅱ型2例)成功排石,其余30例(Ⅰ型2例,Ⅱ型8例,Ⅲ型20例)于术后4-8周行URL。30例石街经URL术后全部取尽。2例Ⅰ型石街因手术时间短,术后未留置双J管,其余28例全部再次置入双J管。30例患者无1例严重输尿管损伤,但4例术后感染加重,予以积极治疗后完全恢复。结论对于Ⅰ型输尿管石街,药物排石效果较好,多采取保守治疗,对于术后Ⅱ或Ⅲ型输尿管石街,因自行排石几率小,建议行手术处理。石街在术后4周内仍未排出者,应积极采用手术干预。Objective To investigate the incidence of ureteral stone street in patients with renal and upper ureteral calculi larger than 2 cm after flexible ureteroscopic lithotripsy(FURL)and the therapeutic effects of minimally invasive intracavitary surgery.Methods Clinical data of 423 cases of renal and upper ureteral calculi with diameter larger than 2 cm treated with FURL at our hospital during Jan.2018 and Dec.2020 were retrospectively analyzed.Ureteral stone street with a length of 1.0-7.5 cm was observed in 46 cases on abdominal plain radiographs(KUB)within 1 day to 2 weeks after operation,including typeⅠin 16 cases,typeⅡin 10 cases and typeⅢin 20 cases.All of these patients received conservative drug treatment for 4-8 weeks.For those with stones still uncharged,ureteroscopic holmium laser lithotripsy(URL)was performed.Results Ureteral stone street was formed in 46 of 423 cases after FURL,with an incidence of 10.9%.After 4 weeks of conservative drug treatment,only 16(14 cases of typeⅠ,2 cases of typeⅡ)successfully excreted the stones,while the remaining 30 cases(2 cases of typeⅠ,8 cases of typeⅡ,20 cases of typeⅢ)underwent URL and successfully removed the stones.Thanks to the short operation time,2 cases of typeⅠureteral stone street did not have ureteral double J tube indwelled,and the other 28 cases had double J tube indwelled again.No serious ureteral injury occurred,but 4 patients had severe postoperative infection and were cured after active anti-infective treatment.Conclusion For typeⅠureteral stone street,drug lithotripsy has good efficacy;for typeⅡorⅢureteral stone street,surgical treatment is recommended.If the stone street cannot be discharged within 4 weeks after operation,active surgical intervention is necessary.

关 键 词：输尿管石街 排石 肾结石 碎石 输尿管软镜钬激光碎石 

分 类 号：R693.4[医药卫生—泌尿科学]