输尿管软镜下钬激光碎石处理直径〉2cm肾结石

目的 探讨输尿管软镜下钬激光碎石术处理直径〉2 cm肾结石的安全性和可行性.方法 2010年2月～2013年4月,采用输尿管软镜下钬激光碎石术处理经选择的直径〉2 cm的肾结石35例.先用F8.0/9.8输尿管硬镜探查、扩张患侧输尿管,置入导丝后留置输尿管软镜鞘,引入输尿管软镜进行钬激光碎石,较大、影响视野的结石碎屑用套石网篮取出.结果 一次进镜成功率94.2%（33/35）.手术时间35~95 min,平均45 min.4例因术后残留较大体积结石再次输尿管镜下钬激光碎石.术后4例出现高热,经积极抗感染治疗后好转,无一例出现术中严重并发症.术后住院1~5 d,平均3 d.术后8周随访,结石清除率90.9%（30/33）;2例少量残留结石碎片停留于输尿管中下段,拔除内支架管时同时取出;1例孤立肾结石术后18周随访（术后8周已拔除内支架管）,仍有结石碎片在输尿管下段未排出,局麻下输尿管镜钳夹取出.结论 输尿管软镜碎石术治疗经选择的直径〉2 cm肾结石,安全、有效,特别对于术后复发的肾结石患者可以避免再次肾脏手术损伤.

Flexible Ureteroscope with Holmium Laser Lithotripsy for Renal Stones of More than 2 cm in Diameter

Objective To evaluate the safety and efficacy of flexible ureteroscopic lithotripsy for renal stones of more than 2 cm in diameter. Methods From February 2010 to April 2013, 35 selected patients with renal calculi of more than 2 cm in diameter underwent flexible ureteroscopic lithotripsy with holmium laser by the same surgeon. After dilation of the ureter with F8.0/9.s rigid ureterosope, the ureteric sheath for flexible ureterosope was inserted to the target ureter followed by flexible ureteroscope. Stones were fragmented by holmium laser, and removed by basket. Results The success rate of ureteroscopic insertion was 94.2% （33/35）. The operation time ranged from 35 to 95 rain with a mean of 45 rain. Four cases had postoperative high fever and relieved after anti- infection treatment and no severe intraoperative complications occurred. The postoperative hospital stay was 1 -5 d （average, 3 d）. The follow-up of 8 weeks showed the stone-free rate was 90.9% （30/33） ; stone fragments retained in the middle and lower ureteral and were taken out along with ureteral stent in 2 eases. Stone fragments retained in the lower ureteral and were taken out with forceps under ureteroscope in 1 ease of solitary kidney 18 weeks after operation. Conclusion Flexible nreteroscopic ithotripsy is a favorable option for patients with renal stones of more than 2 cm in diameter, especially for recurrent renal calculi.