结石CT值测定联合输尿管软镜治疗大负荷肾结石

目的探讨输尿管软镜下单次碎石治疗CT值≤800 HU、直径≥2 cm的肾结石的有效性、安全性和可行性。方法2016年1月~2018年12月我科对30例CT值≤800 HU、直径≥2 cm的肾结石行输尿管软镜下碎石。术前常规放置输尿管支架管2周。全麻后放置输尿管软镜鞘,沿鞘置入F 9.8 Olympus电子输尿管软镜,插入200μm或365μm(结石位于肾盂者)钬激光光纤,钬激光碎石能量设置为1.0 J,频率20~30 Hz,逐步粉碎结石。粉碎后较大结石碎片套石网篮取出。术后留置输尿管支架管1根。结果30例均顺利放置镜鞘并置入输尿管软镜,一次进镜成功率100%。手术时间50~90 min,平均75 min。均无二次手术。28例手术成功,2例术后有残余结石(直径分别为8、10 mm),行体外冲击波碎石术后2~3周排出。5例术后发热,经加强抗炎输液对症处理后,体温降至正常。无输尿管穿孔、出血等并发症。术后住院2~4 d,平均2.4 d。术后随访1年,2例复发,3例发现肾结晶,无特殊处理。结论CT值≤800 HU的大负荷肾结石行输尿管软镜下碎石安全、有效、可行。

Determination of Stone CT Value Combined With Flexible Ureteroscopy for Treatment of Large Load Kidney Stones

Objective To evaluate the safety,efficacy and feasibility of flexible ureterroscopic lithotripsy for treatment of kidney stones≥2 cm in diameter and their CT value≤800 HU.Methods From January 2016 to December 2018,30 patients with renal stones≥2 cm in diameter and their CT value≤800 HU underwent flexible ureteroscopic lithotripsy.A ureteral stent was placed routinely before the operation for 2 weeks,and a sheath was placed after the general anesthesia,along which a F 9.8 Olympus flexible endoscope was placed into.The holmium laser fiber of 200 or 365μm was inserted(the stone located in the renal pelvis),with the energy of holmium laser lithotripsy of 1.0 J and the frequency of 20-30 Hz.The stones were gradually fragmented,and the larger stone fragments were taken out with stone basket.One ureteral stent was retained after operation.Results All the 30 cases were successfully placed the sheath and ureteroscope.The success rate of one-stage access was 100%.The average operation time was 75 min(range,50-90 min).There was no second operation.A total of 28 cases were operated successfully,while other 2 cases had residual stones with diameter of 8 and 10 mm respectively,which were discharged 2 to 3 weeks after ESWL.There were 5 cases of postoperative fever,whose body temperature decreased to normal after the treatment of anti-inflammatory infusion.No ureteral perforation,bleeding or other complications was seen.The average hospitalization time was 2.4 days(range,2-4 d).After 1 year’s follow-up,2 cases recurred(stone size was 7 mm and 6 mm respectively),and 3 cases were found renal crystal without need of special treatment.Conclusion Flexible ureteroscopic lithotripsy for large load kidney stone with CT value≤800 HU is safe,effective and feasible.