软性输尿管镜处理硬性输尿管镜碎石术中结石漂移入肾

摘要

目的：探讨电子软性输尿管镜钬激光碎石治疗硬性输尿管镜碎石术中结石漂移入肾的安全性及疗效。方法回顾性分析我院2012年1月至2015年10月使用电子软性输尿管镜钬激光碎石术处理硬性输尿管镜碎石术中结石漂移入肾45例临床资料，分析软性输尿管镜钬激光碎石手术时间、清石率、术后住院时间、并发症发生率。结果45例患者术前均为输尿管结石，结石直径均小于等于20 mm，术中发现结石23例位于上盏，8例结石位于中盏，3例位于下盏，11例为多个肾盏残石，单枚结石9例，结石直径5～20 mm。45例患者均顺利地置入电子软性输尿管镜，平均手术时间（38±11）min，术后平均住院时间（3±1）d。所有患者无肾盂输尿管严重损伤、大出血、急性肾功能不全、感染性休克等并发症，术后3个月行超声或CT检查证实无结石残留。结论在硬性输尿管镜碎石术中结石漂移入肾的情况下，电子软性输尿管镜钬激光碎石能有效清除漂移结石，并发症少。%Objective To determine the safety and efficacy of flexible ureteroscopic laser lithotripsy in the treatment of stones drifting into the renal pelvis during rigid ureterosope.Methods The clinical data of 45 patients with stones drifting into the renal pelvis during rigid ureterosope treated by flexible ureteroscopic laser lithotripsy in our hospital from January 2012 to October 2015 were retrospectively reviewed. The operative time,stone free rates,postoperative hospital stay,incidence of complications of flexible ureteroscopic laser lithotripsy were ana-lyzed.Results Preoperative stones of 45 cases were all located in the ureter,the stone diameter were or less than 20 mm,intraoperative find-ings 23 cases stones were located in the upper calyx,8 cases situated in middle calyx,3 cases located in lower calyx,1 1 cases were multiple calyx residual stone,single stone 9 cases,the stone diameter was from 5 to 20 mm.All of the 45 patients were successfully placed the flexible ureteroscopy into the ureter,the average operative time was (38 ±1 1 )minutes,mean postoperative hospital stay time was (3 ±1 )days.There was no serious renal pelvis and ureter injury,bleeding,acute renal failure,septic shock and other complications.After 3 months ultrasound or CT scan confirmed no residual stones.Conclusion During the rigid ureteroscopy lithotripsy when stones drift into the renal pelvis,the elec-tronic flexible ureteroscopy can effectively remove the drift stones with fewer complications.