体外碎石失败后行输尿管软镜治疗回顾性分析

目的探讨体外碎石失败后采用输尿管软镜钬激光碎石术的治疗效果,分析其失败原因及相关并发症。方法回顾性分析我院2015年5月～2017年12月158例体外碎石失败后行输尿管软镜治疗的结石患者临床资料。结石直径为0.7～3.5 cm,35例结石合并息肉,均行输尿管软镜下钬激光碎石术治疗,采用钬激光汽化息肉。一般术后放置双J管2周。术中计算钬激光碎石时间、假道、穿孔情况,术后观察是否出现血凝块、发热、术后石街形成、结石排尽情况。结果本组病例一次碎石成功率达97.47%(154/158),手术时间16～78 min,平均(31.16±3.21)min。术后住院天数2～5 d,平均(3.13±0.29)d。其中输尿管结石73例一次成功,1例出现石街,成功率达98.64%(73/74),肾结石、肾盂结石术后有3例出现石街,81例一次成功,成功率达96.43%(81/84)。术后4周行KUB复查结石排净率为94.94%(150/158),肾结石排净率为91.67%(77/84),输尿管结石排净率为98.64%(73/74)。在总病例中,术中发现1例输尿管穿孔,但是无输尿管内膜撕脱、断裂及假道形成。结石在年龄、男女、左右侧等分布比较,无统计学差异;肾结石和输尿管结石在核心CT值和平均直径比较中无明显统计学差异。结论输尿管软镜在泌尿系结石的治疗中,效率高、创伤小、出血少、碎石排净率高,患者并发症少、恢复快,是安全有效的碎石方法。

Retrospective analysis of flexible ureteroscopy after failure of extracorporeal lithotripsy

Objective?To investigate the therapeutic effect of flexible ureteroscopy holmium laser lithotripsy after failure of extracorporeal lithotripsy,and to analyze the causes of failure and related complications.Methods?The clinical data of 158 patients with calculi treated with flexible ureteroscopy after the failure of extracorporeal lithotripsy from May 2015 to December 2017 were retrospectively analyzed.The diameter of the stone was 0.7-3.5 cm.35 cases had stones combined with polyps.All patients underwent flexible ureteroscopy holmium laser lithotripsy.The krypton laser was used to vaporize the polyps.The double Jtube was placed for 2 weeks after surgery.The holmium laser lithotripsy time,false tract and perforation were calculated during operation.The blood clots,fever,postoperative stone street formation,stone discharge were observed after operation.Results?The success rate of lithotripsy for one time in this group was 97.47%(154/158),the operation time was 16-78 min,and the average time was(31.16±3.21)min.The postoperative hospital stay was 2 to 5 days,with an average of(3.13±0.29)days.Among them,73 cases of ureteral calculi were successful for one time,and 1 case appeared stone street,with the success rate of 98.64%(73/74).3 cases appeared stone street after renal stone and renal pelvis surgery,81 cases of kidney stone were successful for one time,and the success rate was 96.43%(81/84).At 4 weeks after operation,the stone discharge rate was 94.94%(150/158)by KUB reexamination,the renal stone removal rate was 91.67%(77/84),and the ureteral stone removal rate was 98.64%(73/74).In the total case,1 case of ureteral perforation was found during surgery,but no ureteral avulsion,rupture and false tract formed.Statistical data showed there was no statistical difference in the distribution of stones in age,male and female,left and right sides.There was no significant difference in renal calculus and ureteral stones between core CT values and mean diameter.Conclusion?Flexible ureteroscopy is a safe and effective method for the treatment of urinary calculi with higher efficiency,less trauma,less bleeding,high rate of stone discharge,and less complications and quick recovery.