电子输尿管软镜钬激光碎石治疗孤立肾结石疗效分析

摘要

目的：：探讨电子输尿管软镜钬激光碎石术治疗孤立肾肾结石的临床疗效.方法：回顾性分析2012年3月~2014年8月应用电子输尿管软镜治疗12例孤立肾结石患者临床资料,男5例,女7例,年龄21~73岁,平均64岁.7例为功能性孤立肾,5例为单侧肾切除术后.所有患者均行泌尿系CTU检查以明确结石大小及位置,术前常规行尿常规、尿培养及血肌酐检查,尿培养阳性者使用敏感抗生素治疗3天.所有患者术前均预置F7双J管2周作输尿管被动扩张.分析手术时间、清石率、并发症以及血清肌酐的变化.结果：12例患者结石大小为1.6~3.2 cm,平均(2.1±0.6)cm,术前肌酐92~178μmol/L,平均(141.90±27.9)μmol/L；手术时间40~200 min,平均117 min,一期结石清除率达83.3％(10/12).2例诊断为全身炎症反应综合征,1例为尿脓毒血症,其中1例出现明显尿量减少,患者经积极治疗后,生命体征逐渐平稳,痊愈出院.术后随访1个月,肌酐为69~182μmol/L,平均(109.8±25.2)μmol/L,与术前比较差异有统计学意义(P＜0.05).结论：电子输尿管软镜图像清晰,治疗孤立肾结石安全高效,值得推广.%Objective:To evaluate the efficacy of electronic fexible ureteroscopy holmium laser lithotripsy in trea-ting renal stones in a solitary kidney.Methods:From March 2012 to August 2014,12 patients with a solitary kidney underwent electronic fexible ureteroscopy holmium laser lithotripsy.All patients received computed tomography to understand the location and size of the stones preoperatively.Preoperative urine culture were done and positive pa-tients were treated by sensitive antibiotics for three days.F7 double-J tube were inserted in all patients to dilate the u-reter for 2 weeks preoperatively.Factors such as operation duration,complications and stone-free rate (SFR)were analysed.Results:The mean age was 64 years (range,21-73 years).The mean stone size was (2.1±0.6)cm (range 1.6-3.2 cm).The mean operation time was 117 min (range 40-200 min).The SFRs was 83.3%.Systemic Inflam-matory response syndrome and urosepsis were respectively recorded in one patient and cured after active treatment. After one month follow-up,the preoperative and postoperative serum creatinine had statistical difference (P<0.05).Conclusions:Electronic fURS holmium laser lithotripsy is an effective and safe procedure with a high SFR and a lower rate of complication in treating renal stones in a solitary kidney.