无扩张鞘下输尿管软镜钬激光治疗≤2cm肾结石的可行性研究

摘要

目的 探讨无扩张鞘输尿管软镜碎石在治疗≤2 cm肾结石中的可行性及安全性.方法 回顾性分析2014年5月至2016年10月间新乡医学院第一附属医院泌尿外科无扩张鞘下输尿管软镜碎石治疗≤2 cm肾结石患者39例(A组)的临床资料(所有患者均为术中置鞘失败),并与同期顺利放置扩张鞘输尿管软镜碎石的46例(B组)患者比较,比较两组患者的一期手术完成率、碎石时间、结石清除率、住院时间、住院费用和术后并发症.结果 两组年龄、性别、结石大小、CT值及部位比较分析差异无统计学意义(P＞0.05),A组手术完成率97.4％(38/39)、碎石时间(50.4土15.5)min、住院时间(3.0±1.6)d、住院费用(14 862.2±1 036.8)元、初始清石率79.4％(31/39)、1月清石率89.7％(35/39)、2例术后2月行体外冲击波碎石1次,1例因无法进镜留置D-J管2周后手术,术后出现发热3例、尿外渗1例、肾绞痛1例,并发症发生率12.8％(5/39);B组一期手术完成率100％(46/46)、碎石时间(34.7±16.5)min、住院时间(2.8±1.7)d、住院费用(15 465.2士1324.6)元、初始清石率89.1％(41/46)、1月清石率91.3％(42/46)、1例术后2月行体外冲击波碎石1次,术后发热2例,并发症发生率4.3％(2/46),所有患者术后3月复查结石均顺利排出.两组患者手术完成率、1月结石清石率、住院时间、住院费用比较差异无统计学意义(P＞0.05),初始清石率、碎石时间、术后并发症比较差异有统计学意义(P＜0.05),两组患者均无严重并发症发生.结论 对于≤2 cm直径结石,无扩张鞘输尿管软镜碎石可以作为扩张鞘置入失败后的有效治疗方法之一.%Objective To investigate the feasibility and safety of flexible ureteroscopy lithotripsy (FURL) without ure teral access sheaths in the treatment of renal calculi ≤2 cm.Methods The clinical data of 39 cases of renal stones ≤2 cm with ureteral access sheath placement failure (group A) and 46 cases who had ureteral access sheath placed successfully using FURL were retrospectively analyzed.The surgical completion rate,lithotripsy time,stone clearance rate,hospital stay,hospitalization expenses and postoperative complications of the two groups were compared.Results There were no statistic differences in age,gender,stone size,CT value and location between the two groups (P＞0.05).There were no significant differences between group A and B in surgical completion rate 97.4 ％ vs.100 ％,hospital stay (3.0 ± 1.6) vs.(2.8± 1.7) d,hospitalization expenses (14 862.2± 1 036.8) vs.(15 465.2± 1 324.6) RMB,stone clearance rate one month after operation 89.7 ％ vs.91.3％,all P＞0.05.There were significant differences between group A and B in the initial stone clearance rate 79.4％ vs.89.1％,lithotripsy time (50.4±15.5) vs.(34.7±16.5) min,and complication rate 12.8％ vs.4.3％,all P＜0.05.Conclusion For renal stones ≤2 cm,flexible ureteroscopy without ureteral access sheaths can be used as one of effective methods in the treatment of ureteral access sheath placement failure.