摘要
目的探讨电子输尿管软镜联合钬激光在手术治疗肾结石中的作用。方法马鞍山市人民医院2014年4月至2016年7月在电子输尿管软镜下钬激光碎石术治疗肾结石160例,结石长径范围为8～45 mm,平均22.5 mm。其中结石位于肾盂106例(多发结石60例),肾上盏15例,肾中盏21例,肾下盏18例。术前留置双J管1～2周,术中先用F8/9.8输尿管硬镜放置斑马导丝,留置输尿管软镜鞘,用电子输尿管软镜探查至肾盂内找到结石,再使用200μm钬激光光纤碎石。术后8周复查腹部尿路平片(KUB),评估结石排净率。结果 159例顺利找到结石(99.3%),一次性碎石成功(156例)97.5%,术后8周复查总结石排净142例(88.5%),手术时间范围为35～220 min,手术时间平均85 min,住院时间范围为6～11 d,住院时间平均9.3 d,无输尿管穿孔、撕脱及大出血等严重并发症。结论电子输尿管软镜下钬激光治疗肾结石是处理肾结石的安全有效的手段,特别对于术后复发的肾结石病人可以避免再次肾脏手术损伤。肾中盏及肾盂内结石较肾下盏结石碎石结石排净率高。
Objective To evaluate the efficacy,safety and prognosis of the electronic flexible ureteroscope combined with Holmium laser for treatment of renal calculi,and to analyze the influencing factors of the success rate of lithotripsy.Methods We retrospectively reviewed the date of 160 patients in Ma’anshan People’s Hospital from April 2014 to July 2016 who underwent the electronic flexible ureteroscopic Holmium laser Lithotripsy.The diameter of the stones ranged from 8 mm to 45 mm with a mean of 22.5 mm.Among the cases,the calculi were located at the renal pelvis in 106 patients(Multiple renal stonei in 60 patients),at the upper calyx in 15,at the middle calyx in 21,at the lower calyx in 18.A pig-tail stent would be set at the beginning of the procedure for 1-2 week.The guide wire was in set under the vision of F8/9.8 rigid ureteroscope,then F12/14 flexible ureteral access sheath.The stones were fragmentized and removed by using 200μm Holmium Laser fiber.A follow-up by KUB was done in 8 weeks after the procedure to evaluated the result of endoscopiec nephrolithotripsy.Results The calculi were detected in 159 patients(99.3%,159/160).The success rate in a single procedure was 97.5%(156/160)).After 8 weeks,the total evacuation rate of the calculi was 88.5%(142/160).The mean operative time was 85 min(35-220 min),and mean hospital stay was 9.3 d(6-11 d).No serious complications were found,such as ureter perforation,avulsion and hemorrhage.Conclusion The electronic flexible ureteroscope combined with Holmium laser lithotripsy is safe and effective for renal calculi sized,especially for recurrent renal calculi.The total evacuation rate of the calculi in the middle poles and renal pelvis was better than at the lower calyx.
作者
郑奇传
蒋堃
邵恩明
徐刚
陈翔
徐伟
叶杨
ZHENG Qichuan;JIANG Kun;SHAO Enming;XU Gang;CHEN Xiang;XU Wei;YE Yang(Department of Urology,Ma’anshan People’s Hospital,Ma’anshan,Anhui 243000,China)
出处
《安徽医药》
CAS
2019年第5期949-951,共3页
Anhui Medical and Pharmaceutical Journal
关键词
肾结石
输尿管镜检查
碎石术
激光
钬
肾盏
结石排净率
Kidney calculi
Ureteroscopy
Lithotripsy,laser
Holmium
Kidney calices
Evaluation rate of the calculi
