摘要
目的探讨肾下盏解剖结构对输尿管软镜下钬激光碎石治疗肾下盏结石疗效的影响。方法选取2007年1月至2011年12月肾下盏结石患者60例，男38例，女22例。年龄23～78岁，平均51岁。平均身高169．8cm，平均体质量71．2kg。均行IVU检查，测量肾盂输尿管与肾下盏漏斗部夹角、肾下盏漏斗部长度及最窄处宽度，分析其与输尿管软镜下钬激光碎石术疗效间的关系。结果本组60例中，42例治愈，年龄（50．1±14．6）岁，体质量（71．4±5．5）kg，身高（169．8±5．1）cm，结石最大径（10．9±2．1）mm，结石面积（85．4±9．5）mm2，盏颈长度（36．3±3．7）mm，盏颈宽度（4．9±1．4）mm；18例未治愈，年龄（51．7±11．7）岁，体质量（70．6±4．7）kg，身高（169．9±6．4）cm，结石最大径（11．3±2．4）mm，结石面积（82．5±8．6）mm2，盏颈长度（37．2±2．3）mm，盏颈宽度（4．8±1．9）mm，两组比较差异均无统计学意义（P〉0．05）。肾盂输尿管与肾下盏漏斗部夹角治愈组为（63．4±23．2）°，未治愈组为（45．3±17．6）°，两组比较差异有统计学意义（P〈0．05）。夹角≥45。者清石率为84．6％，〈45。者清石率为42．7％，两组比较差异有统计学意义（P〈0．05）。按肾盂输尿管与肾下盏漏斗部夹角进行分组，夹角〉90°组治愈率为92．3％（12／13），夹角30°～90°组为73．2％（30／41），夹角〈30°组为0％（0／6）。Logistic回归分析结果表明肾盂输尿管与肾下盏漏斗部夹角是输尿管软镜下钬激光碎石术疗效的独立影响因素（OR=1．12，P〈0．05）。结论肾盂输尿管与肾下盏漏斗部夹角大小直接影响输尿管软镜下钬激光碎石术治疗肾下盏结石的疗效，夹角越小，碎石效果越不理想。
Objective To evaluate the impact of lower renal calyceal anatomic structure on flexible fibreoptic ureteroscopy with holmium laseriu treatment of calyceal calculi. Methods From January 2007 to December 2011, a total of 60 patients with a lower calyceal renal stone were enrolled in this study. The mean age was 51 years （range 23 to 78 years）. The mean height was 169.8 cm, and mean body mass was 71.2 kg. Intravenous urogram （IVU） was performed on all patients and the lower pole anatomy （including infundibulopelvic angle, length of the inferior caliceal infundibulum and infundibular width） were measured in these patients. The correlation between lower pole anatomy and the success of flexible flbreoptic ureteroscopy with holmium laser for calyceal calculi was analyzed. Results Of the 60 patients, 42 patients were successful in stone clearance. The patients in the stone-free group age of （50. 1 ± 14.6） years, height （169.8 ±5.1） cm, body mass （71.4±5.1） kg, the maximum stone size in diameter （10.9±2.1） ram, stone burden （85.4 ± 9.5 ） mm2 , lower infundibular length （36.3 ± 3.7） mm and lower infundibular width （4.9 ±1.4） ram; the other 18 patients age （50.7 ±11.7） years, height （169.9 ±6.4） cm, body mass （71.6 ±4.7） kg, the maximum stone size in diameter （11.3 ±2.4） mm, stone burden （82.5 ±8.6） mm2, lower infundibular length （37.2 ± 2.3 ） mm and lower infundibular width （4.8 ± 1.9） mm. There was no difference between the stone-free group and the residual group in all above parameters （P 〉 0.05）. However, the infundibulopelvic angle in the stone-free group was significantly greater than that in the residual group （63.4 ± 23.2 vs 45.32 ± 17, 6, P 〈 0.05）. X2 test showed the stone clearance rate in patients with angle I〉45 was better than that in those with angle 〈 45 （84.6% vs 42.7% , P 〈 0.05）. If grouped by infundibulopelvic angle, patients with infundibulopelvic angle greater than 90±had stone clearance rate 92.3% （12/13） , those with angle ranged from 30± to 90± had 73.2% （30/41） , and those with infundibulopelvic angle smaller than 30± had 0% （0/6）. Logistic regression analysis showed that the angle was a significant independent predictor of stone clearance （ OR = 1. 12, P 〈 0.05）. Conclusions The infundibulopelvic angle has adverse influences on the performances of flexible ureteroseopy. The samller the angle is, the poo- rer the performances of flexible ureteroscopy is.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2013年第1期24-27,共4页
Chinese Journal of Urology
关键词
肾脏
输尿管软镜
钬激光
肾下盏结石
Kidney
Flexible fibreoptic ureteroscopy
Holmium laser
Calyceal calculi
