经软性输尿管镜钬激光碎石治疗直径大于2cm肾结石疗效分析

目的探讨经软性输尿管镜钬激光碎石治疗直径大于2 cm肾结石的临床应用价值。方法回顾性分析2016年8月~2017年3月间的45例直径大于2 cm肾结石患者的临床资料,对45例直径大于2 cm肾结石患者行经软性输尿管镜钬激光碎石术治疗。结果肾结石平均直径(26.5±5.9)mm。1次手术成功碎石27例(60%),2次手术碎石18例(40%),无行第3次手术碎石患者。平均手术碎石次数(1.40±0.49)次。术后2期行体外震波碎石(ESWL)11例。在治疗后的1个月随访中,总体的结石清除率为88.9%(40/45),平均手术时间为(72.6±27.5)min,术后出现并发症4例(8.8%)。术前合并尿路感染组住院时间明显延长(P0.05),其手术时间、术后并发症及结石清石率与无感染组比较,差异无统计学意义(P0.05)。下盏结石组与其他部位结石组相比,其手术时间、住院时间、术后并发症及结石清除率比较,差异无统计学意义(P0.05)。结论经软性输尿管镜钬激光碎石治疗直径大于2 cm肾结石安全有效,并发症发生率低,患者恢复快,易于临床应用;下盏结石及术前合并尿路感染并不影响手术疗效及术后并发症。

Efficacy analysis of flexible ureteroscopic lithotripsy with holmium laser in the treatment of kidney stones with diameter greater than 2 cm

Objective To explore the clinical application value of flexible ureteroscopic lithotripsy with holmium laser in the treatment of kidney stones with diameter greater than 2 cm.Methods The clinical data of 45 cases of diameter greater than 2 cm kidney stones from August 2016 to March 2017 were retrospectively analyzed.The 45 cases of diameter greater than 2 cm kidney stones were treated with flexible ureteroscopic holmium laser lithotripsy.Results The average diameter of kidney stones was(26.5±5.9)mm.There were 27 cases of one-time surgery successful gravel(60%)and 18 cases(40%)of two-time surgery successful gravel.And there were no cases of the third surgery lithotripsy.The average number of operative crushed stones was(1.40±0.49)times.There were 11 cases of extracorporeal shock wave lithotripsy(ESWL)in the postoperative period 2.Within 1-month follow-up after treatment,the total stone clearance rate was 88.9%(40/45),and the average operation time was(72.6±27.5)min,and there were 4 cases of postoperative complications(8.8%).The hospitalization time was significantly prolonged in preoperative urinary tract infection group(P<0.05).There were no significant differences in the operative time,postoperative complications and stone clearance rate between the preoperative infection group and non-infection group(P<0.05).There were no significant differences in the operation time,the hospitalization time,the postoperative complications and the stone clearance rate between the lower calculi group and other parts stone group(P>0.05).Conclusion The flexible ureteroscopic lithotripsy with holmium laser in the treatment of kidney stones with diameter greater than 2 cm is safe and effective.The incidence of complications is low,and the recovery of patients is quick and the treatment is easy to be used clinically.Lower urinary calculi and preoperative urinary tract infection do not affect the curative effect of operation and postoperative complications.