输尿管硬镜联合软镜处理>2cm的特殊类型肾结石被引量：5

Rigid combined flexible ureteroscopy and Holium laser lithotripsy is effective and safe in the treatment of kidney stones>2cm

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摘要目的探讨输尿管硬镜联合输尿管软镜在大于2cm的特殊肾结石中的应用价值。方法本实验选取70例患者（年龄为35~72岁）,其中肾盂结石44例,肾盏结石26例。1肾盂结石：Ⅰ期行输尿管硬镜钬激光碎石,尽量将结石粉碎,术后留置双J管1~4周,Ⅱ期行输尿管软镜钬激光碎石术清除肾内残余结石;2肾盏结石：Ⅰ期于患侧留置双J管1~4周,Ⅱ期行输尿管软镜钬激光碎石术治疗。对手术次数、手术时间、结石清除率（术后无结石残留）、住院时间、手术并发症等进行分析;并比较术前术后血清肌酐（Scr）、肾小球滤过率（GFR）情况。结果Ⅰ期硬镜碎石留置双J管后,结石清除率为（8%）;Ⅱ期软镜下行钬激光碎石取石,结石清除率95.2%。两次平均手术时间及住院时间分别为（46.2±2.3）（50~145）min、（7.5±0.6）（6~15）d。术前与术后1月血清Scr分别为（100.6±1.23）（66.2~151.4）μmol/L、（83.7±4.8）（58.6~116.7）μmol/L（P〈0.05）;GFR分别为（57.6±2.4）（30~115）mL/min、（65.4±0.2）（72~120）mL/min（P〈0.05）。手术顺利,术后有3例出现高热,1例发展为脓毒血症,经保守治疗均痊愈。结论输尿管硬镜联合软镜是治疗特殊肾结石的一种安全有效的方法。 Objective To evaluate the efficacy and safety of rigid combined flexible ureteroscopy and Holium laser lithotripsy in the treatment of kidney stones〉2 cm.Methods A total of 70 consecutive patients aged35-72 years were involved,including 44 cases of pelvic calculi and 26 cases of calyx calculi.For pelvic calculi,rigid ureterorenoscopy was adopted as the first-stage treatment,a double-J was left in this side of kidney for 1-4 weeks,and then the residual stones were removed with flexible ureterorenoscopy.For calyx calculi,in the first-stage,a double-J was left in this side of kidney for 1-4 weeks,and then flexible ureteroscopy was performed to remove the stones.The number of procedures,operation time,stone-free rate,hospitalization time and complications were evaluated.Stone-free status was defined as the absence of fragments.Serum creatinine（Scr）and glomerular filtration rate（GFR）were measured preoperatively,and 3 months postoperatively.Results The initial stone-free status was achieved in8% of the patients after rigid ureteroscopy,and the final stone-free rate（SFR）reached95.2% after the second procedures.The mean operation time and mean hospitalization time were（46.2±2.3）（50-145）min and（7.5±0.6）（6-15）days,respectively.During preoperative period and postoperative period（1 month）,Scr was（100.6±1.23）（66.2-151.4）μmol/L and（83.7±4.8）（58.6-116.7）μmol/L,respectively（P〈0.05）,while GFR were（57.6±2.4）（30-115）mL/min and（65.4±0.2）（72-120）mL/min,respectively（P〈0.05）.No major intraoperative complications were identified.Postoperative high-grade fever was observed in3 patients,including 1 patient who developed sepsis.All these patients were successfully treated conservatively.Conclusions Rigid combined flexible ureteroscopy and holium laser lithotripsy is a safe and efficacious modality in the treatment of special kidney stones.

作者索朗次仁

机构地区西藏山南地区人民医院普通外科

出处《现代泌尿外科杂志》 CAS 2016年第3期203-205,共3页 Journal of Modern Urology

关键词肾结石输尿管硬镜输尿管软镜 kidney stones rigid ureteroscopy flexible ureteroscopy

分类号 R692.4 [医药卫生—泌尿科学]

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