目的 评价输尿管软镜钬激光碎石术的疗效及安全性,探索输尿管软镜钬激光碎石术后石街的发生率及其危险因素.方法 本前瞻性研究纳入2013年5月至2013年12月四川大学华西医院泌尿外科行输尿管软镜钬激光碎石术的患者共156例.采集患者年龄、性别等人口学信息,结石大小、部位和数量,发热、出血、下尿路刺激症状等术后并发症.采用 Logistic回归分析评估石街的危险因素.结果 输尿管软镜钬激光碎石术治疗肾或输尿管上段结石的I期结石清除率为83.3% 、Ⅱ期结石清除率为98.1%.需进行干预的术后并发症包括发热10例(6.4% )、下尿路刺激症状2例(1.2% )、出血1例(0.6% )等,其总体发生率为8.2%.术后石街发生率为5.8%.以结石累积最大径线(CSD)为例,进行分层分析发现,CSD<10 mm、10~20 mm、20~30 mm、>30 mm的患者石街形成率分别为0% 、4.9% 、17.4% 、20.0%.Logistic回归分析发现:石街与结石负荷、患者性别、年龄、患肾GFR、尿路感染、结石位置、碎石时间等均没有相关性(P>0.05).结论 输尿管软镜钬激光碎石术治疗肾或输尿管上段结石是有效且安全的.人口学特征、患肾功能、结石部位及负荷等因素均不是术后石街发生的危险因素.%Objective To evaluate the efficacy and safety of flexible ureteroscopy (f-URL),and explore the risk factors of steinstrasse (SS) after this treatment.Methods A total of 156 patients treated with f-URL during May and Dec.2013 were involved.Characteristics of patients,stones and complications were recorded.Statistical analysis was performed to detect the predictive factors for the formation of SS.Results The overall stone-free rate was 98.1%.The incidence of complica-tions was 8.2%,including fever in 10 cases,lower urinary tract symptoms (LUTs) in 2 cases,and hemorrhage in 1 case.After f-URL,9 patients suffered SS,8 of them had renal stones and 1 had ureteral stones.The total incidence of SS was 5.8%.The SS located in proximal ureter was 4,midureter was 1 and distal ureter was 4.The incidences of SS with stone surface area <10 mm,10~20 mm,20~30 mm,and >30 mm were 0%,4.9%,17.4%,and 20.0%,respectively.Statistical analysis indicated that formation of SS was not related to stone burden,stone location,sex,age,GFR,UTIs and time of lithotripsy.Conclu-sion Ureteroscopy for urinary stones produce good stone-free rate with low morbidity.Characteristics of patients,renal function,stone burden and location are not risk factors of SS.
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