输尿管软镜是否可以反复用于治疗大的肾结石?

摘要

Renal calculus is one of the most common urological diseases ,and the treatment of renal calculi greater than 2 cm has been the focus of urologists .For a long time ,percutaneous nephrolithotomy (PCNL) is the preferred treatment ,but it may cause impairment of renal function ,intraoperative and postoperative bleeding ,septic shock and other serious complica-tions .Besides ,it is not applicable for patients with solitary kidney and coagulation disorders .Fortunately ,flexible ureterosco-py (FURS) makes up the deficiency of PCNL .FURS is safe and effective ,for it largely reduces damage on renal function and incidence of massive hemorrhage .Therefore ,FURS has become an important treatment approach for patients with high risk PCNL .However ,due to the limitations of equipment ,FURS is unable to completely remove the stones in one session .Can FURS be performed repeatedly to treat large renal calculi?We consider that FURS can be performed repeatedly for 3 times at the most .The number of operation depends on the patient's general condition ,renal anatomy ,property of the stones ,subjec-tive wishes and economic capability .%肾结石是泌尿外科最常见的疾病之一.而>2 cm肾结石的治疗也一直是泌尿外科医师关注的一个焦点.经皮肾镜取石术 (PCNL)被认为是>2 cm肾结石治疗的首选方法 ,但仍面临着肾功能损害、术中术后大出血、感染性休克等严重并发症.输尿管软镜(FURS)很大程度上减少了肾功能损害、大出血的发生率 ,具有良好的安全性.而 FURS在>2 cm肾结石的治疗中也表现出了高效性.但另一方面 ,治疗较大肾结石时 ,FURS往往不能将结石一次性清除.FURS是否可以反复用于治疗大的肾结石?限制次数是多少?我们认为 ,FURS是一种安全有效的手术方式 ,可以反复实施 ,手术次数不要大于3次 ,具体应由患者的基础情况、肾脏解剖结构、结石的性质以及患者的主观意愿和经济承受能力等决定.