采用软性输尿管镜技术治疗经皮肾镜取石术后残留结石的临床分析

发布时间：2018-06-23 18:36

本文选题：软性输尿管镜技术 + 经皮肾镜取石术　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨采用软性输尿管镜技术治疗经皮肾镜取石术(PCNL)后残留结石的临床应用价值。方法:选择2014年12月至2016年10月期间,在广西医科大学第一附属医院泌尿外科经PCNL治疗术中、术后残留有结石的患者52例,采用逆行经腔内碎石(RIRS)或顺行经肾造瘘通道输尿管软镜碎石(AFU)进行治疗。其中男37例,女15例,年龄23-59岁,平均45±6.4岁。PCNL后时间0-61天。52例患者术后均有双J管留置史,其中10例仍留置有肾造瘘通道。本组52例患者中,行PCNL过程中仅建立一个通道的48例(92.3%),仅4例(7.7%)建立两个以上通道。绝大多数患者肾内残留至少2颗以上的多发结石,分布于1至7个肾盏;而单颗残留结石则直径为0.8-2.4厘米;阴性结石则直径大于0.5厘米。统计手术时间,术后出院时间,感染发生率,输血率,二次RIRS手术率,净石率指标。结果:52例患者中,47例(90.4%)直接行RIRS;5例(9.6%)行AFU,其中2例失败,保留肾造瘘管择期改行RIRS后成功碎石。行RIRS的49例患者中,5例(10.2%)行2次RIRS,44例(89.8%)仅行一次RIRS。软性输尿管镜操作手术时间20-90分钟(平均42±17分钟)。48例(92.3%)成功找到肾内全部结石并完全击碎,2例(4%)未能全部找到肾内结石,2例(4%)找到结石,但因角度大无法碎石。术后出现发热2例,无继发低氧血症、休克等尿源性脓毒血症表现,经抗感染治疗后均治愈出院。留置肾造瘘管的10例患者术后均无发热。全部患者术中、术后无严重血尿病例,无输血病例。平均术后出院时间1.3±0.3天。术后2至8周全部患者回院复诊并拔除双J管。拔除双J管当日发现肾内或输尿管上段仍有残留结石(已经击碎,碎石直径小于0.3厘米)23例(44.2%)。4例结石未能完成碎石的患者中,3例改行体外冲击波碎石术(ESWL),1例长期随诊观察处理。拔除双J管后33例随诊1-6月,其中28例(84.8%)结石排净。结论:软性输尿管镜技术是处理PCNL术后残留结石的有效手段。
[Abstract]:Objective: to evaluate the clinical value of soft ureteroscopy in the treatment of residual stones after percutaneous nephrolithotomy (PCNL). Methods: from December 2014 to October 2016, 52 patients with residual stones were treated with PCNL in Urology, first affiliated Hospital of Guangxi Medical University. Patients were treated with retrograde endovascular lithotripsy (RIRS) or retrograde ureteral soft lithotripsy (AFU). Among them, 37 males and 15 females aged 23-59 years, mean 45 卤6.4 years. The mean time after PCNL was 0-61 days. 52 patients had a history of double J tube indwelling after operation, and 10 of them still had renal fistula channels. Of the 52 patients, 48 (92.3%) had only one channel established during PCNL, and only 4 (7.7%) had established two or more channels. Most of the patients had at least two or more residual stones in the kidney, which were distributed in 1 to 7 renal calyces, while the diameter of single residual stones was 0.8-2.4 cm, and the diameter of negative stones was more than 0.5 cm. Operation time, postoperative discharge time, infection rate, blood transfusion rate, secondary RIRS operation rate, net stone rate index. Results among 52 cases, 47 cases (90.4%) were treated directly with RIRSN, 5 cases (9.6%) were treated with AFU, of which 2 cases failed. The successful lithotripsy was performed after selective transposition of RIRS with reserved renal fistula tube. Of 49 patients with RIRS, 5 (10.2%) received RIRSV twice, 44 (89.8%) received RIRS2 only once. The operation time of soft ureteroscopy was 20-90 minutes (mean 42 卤17 minutes). 48 cases (92.3%) were successfully found all the stones in the kidney and 2 cases (4%) failed to find all the stones in the kidney. There were 2 cases of fever after operation, no secondary hypoxemia, shock and other manifestations of urogenic sepsis. All cases were cured and discharged after anti-infection treatment. No fever was found in 10 patients with renal fistula. There were no serious hematuria cases and no blood transfusion cases in all patients. The average postoperative discharge time was 1.3 卤0.3 days. From 2 to 8 weeks after operation, all patients returned to hospital and removed double J tubes. In 23 (44.2%) of 23 patients (44.2%) who were found to still have residual stones in the upper part of the kidney or ureter on the day of removal of double J tubes, 3 cases were treated with extracorporeal shock wave lithotripsy (ESWL) and 1 case was followed up for a long time. 33 cases were followed up for 1 to 6 months after removal of double J tubes, of which 28 cases (84.8%) had stones removed. Conclusion: soft ureteroscopy is an effective method to treat residual stones after PCNL.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699

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