一期软性输尿管镜治疗上尿路结石的置鞘成功率及疗效分析

目的探讨术前未预置双J管一期软性输尿管镜治疗上尿路结石置鞘成功率及临床疗效。 方法回顾性分析2018年1月至2020年6月在绍兴文理学院附属医院行一期软性输尿管镜碎石的255例上尿路结石患者的临床资料,分析一期置鞘成功率、一期手术成功率、结石清除率及并发症发生情况。 结果8.5 F软性输尿管镜碎石,一期置鞘总成功率为92.9%（237/255）。其中10/12 F组置鞘成功率91.6%（141/154例）,置鞘成功和失败患者之间性别差异有统计学意义（P<0.05）;12/14 F组置鞘成功率95%（96/101例）,置鞘成功和失败患者之间在术前肾积水和肾功能方面差异有统计学意义（P<0.05）,进一步行多因素Logistic回归分析表明性别（P=0.014）是置鞘失败的独立危险因素。一期手术成功率为85.5%（218/255）,术后3个月清石率88.5%（177/200）。总并发症发生率为23.5%（60/255）,术中输尿管1级损伤25例,2级损伤6例,3级损伤1例;术后发热22例,其中全身炎症反应综合征5例,尿源性脓毒血症1例;出现包膜下血肿1例;出现肾功能不全5例;未出现感染性休克、输尿管石街和输尿管狭窄等严重并发症。 结论不预留双J管一期软性输尿管镜碎石治疗也具有较高的置鞘成功率及手术成功率,清石率高,安全可靠,女性患者置鞘成功率更高。

Analysis of success rate of ureteral access sheath insertion and efficacy of stage I flexible ureteroscopic lithotripsy for upper urinary calculi

ObjectiveTo investigate the success rate of ureteral access sheath (UAS) insertion and efficacy of stage I flexible ureteroscopic lithotripsy (f-URL) in treatment of upper urinary calculi without indwelling double-J stent previously. MethodsA total of 255 patients with upper urinary calculi treated by stage I f-URL in our hospital from January 2018 to June 2020 were analyzed retrospectively. The success rate of UAS insertion and surgery, the stone-free rate and the incidence of complications were calculated. ResultsThe success rate of UAS insertion was 92.9%(237/255), and the success rate of one-stage operation was 85.5%(218/255). The success rate of UAS insertion in 10/12 F group was 91.6%(141/154), there was significant difference in gender between successful and unsuccessful patients (P<0.05). The success rate of UAS insertion in 12/14 F group was 95%(96/101), there was significant difference in hydronephrosis and preoperative renal function between successful and unsuccessful patients. Further multivariate logistic regression analysis showed that gender (P=0.014) were the risk factors for the failure of UAS insertion.The stone-free rate was 88.5%(177/200) three month after the operation. The total complication rate was 23.5%(60/255). During operation, there were 25 cases of grade 1 ureteral injury, 6 cases of grade 2 ureteral injury and 1 case of grade 3 ureteral injury. There were 22 cases of postoperative fever, including 5 cases of systemic inflammatory response syndrome and 1 case of urosepsis. Subcapsular hematoma occurred in 1 case. There were 5 cases of renal insufficiency, but no serious complications such as septic shock, ureteral stone street and ureteral stricture. ConclusionStage I f-URL without indwelling double-J stent has a high success rate of UAS insertion and surgery with a high stone-free rate, is also a safe and reliable procedure. Female patients are more likely to experience intraoperative success to insert UAS.