标准化技术输尿管软镜钬激光碎石术治疗输尿管近端及肾结石:单中心140例报告

发布时间：2018-05-09 22:09

本文选题：输尿管软镜 + 输尿管近端结石　；参考：《中国微创外科杂志》2015年12期

【摘要】：目的评价标准化技术输尿管软镜钬激光碎石术治疗输尿管近端及肾结石的疗效和安全性。方法 2012年10月~2014年10月对140例输尿管近端及肾结石采用标准化技术输尿管软镜钬激光碎石术,术前均行KUB、IVP或CTU检查,38例肾结石术前预置双J管10~14 d,术中应用纤维或电子纤维输尿管软镜和200μm钬激光光纤,先输尿管硬镜探查留置导丝及导引鞘,再置入输尿管软镜碎石,合并输尿管近端结石者先用硬镜使结石回退进入肾盂再用软镜处理。术后留置双J管,口服药物排石1~2个月,2个月内复查KUB。结果手术时间36~243 min,平均114.7 min;估计出血量2~100 ml,平均11.4 ml。除4例髓质海绵肾外,肾结石清除率91.7%(77/84);肾及输尿管近端结石清石率94.8%(129/136)。结石负荷2 cm者,平均手术时间128.5 min(63~213 min),结石清除率71.4%(10/14)。术前预置双J管与未置双J管的患者一期进镜成功率分别为100%(38/38)和82.0%(41/50)。术后住院1~5 d,平均3.6 d。未出现严重损伤性并发症。8例术后出现严重尿源性感染,菌血症发生率5.7%(8/140),其中肾结石患者的发生率为9.1%(8/88),结石负荷2 cm者发生率28.6%(4/14)。结论对于严格筛选的患者,采用标准化技术的输尿管软镜钬激光碎石技术治疗输尿管近端及肾结石安全有效,但对于结石负荷2 cm者,有效性、安全性均下降。
[Abstract]:Objective to evaluate the efficacy and safety of standardized technique of ureteroscopic holmium laser lithotripsy for the treatment of proximal ureteral and renal calculi. Methods in October, ~2014, October 2012, 140 cases of ureteral proximal and renal calculi were treated by standardized technique of ureteroscopic holmium laser lithotripsy. Before operation, KUB, IVP or CTU were performed, and 38 cases of renal calculi were predisposed before operation. J tube 10~14 D, intraoperative fiber or electronic fiber ureteroscopy and 200 mu m holmium laser optical fiber, first ureteroscopic exploration of indwelling guide wire and guide sheath, and then ureteroscopic lithotripsy, combined with ureteral calculi in the proximal ureteral lithiasis to the renal pelvis and reusing the soft mirror. After the operation, the double J tube was retained and the oral medicine was taken for 1~2. In the month, 2 months, the results of the reexamination of KUB. results were 36~243 min, average 114.7 min, the estimated bleeding volume 2~100 ml, average 11.4 ml. except 4 cases of medullary sponge kidney, kidney stone clearance rate 91.7% (77/84), kidney and ureteral stone removal rate of 94.8% (129/136). Stone load 2 cm, average operation time 128.5 min (63~213), stone clearance 71.4% (63~213). 14). The successful rate of pre operation with double J tube and non double J tube was 100% (38/38) and 82% (41/50). 1~5 d after operation, the average 3.6 D. had no serious injury complications. Severe urinary source infection was found after operation, and the incidence of bacteremia was 5.7% (8/140). The incidence of renal calculi was 9.1% (8/88), and the stone load was 2 C. The incidence of M is 28.6% (4/14). Conclusion for patients with strict screening, ureteroscopic holmium laser lithotripsy with ureteroscopy with standardized technique is safe and effective for the treatment of proximal ureteral and renal calculi, but the effectiveness and safety of the patients with a load of 2 cm are decreased.

【作者单位】：北京大学第三医院泌尿外科;
【分类号】：R699

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