组合式输尿管软镜联合钬激光碎石术治疗上尿路结石143例

摘要

Objective To study the safety and efficacy of combined use of flexible ureteroscopy with holmium laser lithotripsy for renal and upper ureter calculi . Methods From June 2013 to October 2015, a total of 143 cases of renal and upper ureter calculi, sized 6-35 mm in diameter, were treated by flexible ureteroscopy combined with holmium laser lithotripsy in our hospital .A double-J stent was not required or placed for a week before procedure .A rigid ureteroscopy was inserted to observe the ureteral lumen , then a ureteric access sheath was placed and a flexible ureteroscopy combined with holmium laser lithotripsy was used to perform the procedure .When the insertion of rigid ureteroscopy and ureteric access sheath was difficult , the flexible ureteroscpy would be inserted directly via a guide-wire.If the flexible ureteroscopy could not be applied , a F6 double-J stent would be set up , and the second ureteroscopy procedure would be tried after 1-2 weeks.A follow-up by KUB or renal ultrasound was done 4 weeks after the procedure to evaluate the results. Results The stent had not been placed in the ureter before operation in 47 cases, and the insertion of sheath was successful in 68.1%(32/47) cases.The stent had been placed in the ureter for 1-2 weeks in 96 cases, and the insertion of sheath was successful in 97.9%(94/96) cases.There was significant difference between the two groups (χ2 =26.806, P=0.000). The average operation time was 110 min (range, 45-180 min).The calculi were detected under ureteroscopy in 133 out of 143 cases (93.0%).The successful rate of stone removal at 4 weeks after holmium laser lithotripsy was 90.2%(120/133).No serious complications occurred except 18 postoperative febrile patients . Conclusions Flexible ureteroscopy combined with holmium laser lithotripsy is a safe and effective procedure for upper tract calculi , being a good option for managing renal and upper ureter calculi . Preoperative stent indwelling in the ureter can improve the success rate of sheath insertion .%目的：探讨组合式输尿管软镜下钬激光碎石术治疗上尿路结石的安全性和疗效。方法2013年6月～2015年10月我们对143例6～35 mm肾结石及输尿管上段结石施行输尿管软镜钬激光碎石术，术前不留置或留置输尿管支架1周，术中先输尿管硬镜探查输尿管，然后放置输尿管鞘并用组合式输尿管软镜钬激光碎石。如果输尿管鞘无法置入，可直接在导丝引导下置入输尿管软镜至结石位置；如果软镜仍不能直接置入，留置F6输尿管支架1～2周后，二期输尿管软镜碎石。术后4周复查腹部平片或泌尿系彩超评估效果。结果47例术前未留置输尿管支架管，进鞘成功率68．1％（32／47）；96例术前留置输尿管支架管1～2周，进鞘成功率97．9％（94／96），2组比较有明显统计学差异（χ2＝26．806， P＝0．000）。手术时间45～180 min，平均110 min。进镜后结石寻及率93．0％（133／143）。钬激光碎石术后4周后排石成功率90．2％（120／133）。除18例术后发热外并无严重并发症。结论组合式输尿管软镜联合钬激光治疗上尿路结石安全、疗效满意，可作为输尿管上段结石及肾结石的理想治疗方案。术前留置输尿管支架能有效提高进鞘成功率。