论文部分内容阅读
目的:探讨输尿管软镜钬激光碎石术同期治疗双肾及双侧输尿管上段结石的临床应用价值.方法:回顾性分析2013年7月至2017年3月58例采用输尿管软镜钬激光碎石术同期治疗双肾及双侧输尿管上段结石患者临床资料.结果:本组58例均顺利放置软镜鞘,一次进镜成功率100％.手术平均101.4±28.9min,平均术后住院时间4.0±1.5d.术中无大出血、输尿管或肾盂穿孔、输尿管撕脱等并发症发生,术后5例出现尿路感染,经积极抗感染治疗后好转.术后第2日复查腹部站立位平片,36例多发结石有部分残留,残石均位于下盏,大小0.2cm～0.6cm.因无梗阻且无症状,予保守观察.22例无结石残留,39例患者于术后2～4天出院.术后1个月复查KUB或彩超,13例残留结石约0.3cm左右,属无意义结石,予保守治疗;5例残留结石0.5cm～0.6cm,其中3例予二次单侧输尿管软镜钬激光碎石治疗,1例予体外冲击波碎石治疗后痊愈,1例为海绵肾合并结石,残余结石0.6cm,无症状体征,予保守治疗.同期双侧输尿管软镜治疗双肾及双侧输尿管上段结石结石清除率为91.4％(53/58).结论:输尿管软镜钬激光碎石术同期治疗双肾及双侧输尿管上段结石创伤小、并发症少,结石清除率高、具有较高的临床应用价值.","Objective To evaluate the clinical effect of one-stage flexible ureteroscopy with holmium laser lithotripsy on the treatment of dual renal calculi and/or dual upper ureter calculi. Methods A retrospective analysis of 58 cases of dual renal or/and dual upper ureter calculi, wich were treated by using flexible ureteroscopy with holmium laser lithotripsy in our hospital from July 2013 to March 2017. Results Flexible ureterorenoscopes were successfully placed in all patients.The average operative time and hospital stay after surgery were 101.4±28.9 minutes and 4.0±1.5 days respectively.No severe complications occured.5 patients had fever after the procedure and then was improved by anti-inflammation. Re-examination by KUB on the second day after the surgery showed no displacement of double-J tube,but visible granular high density (sized between 0.2cm to 0.6cm in diameter) in kidney in 36 patients.In one month after operation,KUB or B-ultrasonography confirmed that most residual stones were discharged spontaneously. The residual stones (diameter,0.5-0.6cm) were observed in 5 cases, of which 3 cases were under second operation and 1 case were under ESWL1 residual stone (diameter, 0.6cm)was in a Medullary Sponge Kidney.Because the patient was symptom free, further operation was not needecLThe stone -free rate was 91.4％(53/58).Condusion One-stage flexible ureteroscopy combined with holmium laser lithotripsy is a safe, feasible and effective method for dual renal and dual upper ureter calculi, with minimally nvasion, high clearance rate of stone and less complication.