摘要
目的探讨组合式输尿管软镜配合手助肋脊角托举处理下组肾盏结石的临床应用价值。方法 2011年10月至2013年8月,盱眙县人民医院治疗17例下组肾盏结石,结石直径11-19 mm,平均15 mm。全麻,截石位,输尿管硬镜下拔除预先留置的双J管,插入斑马导丝,在导丝引导下置入输尿管导引鞘,组合式输尿管软镜沿鞘上行至肾盂,软镜头端向下组肾盏弯曲,置入200μm钬激光,在患侧体外手助托举肋脊角的辅助下寻及结石,予以碎石。术后常规留置5 F双J管4-6周,留置导尿管2-7 d。术后2-3 d常规复查腹部平片（KUB）平片或超声,了解结石粉碎情况及双J管位置。结果本组17例患者中,结石寻及率88.2%（15/17）,碎石成功率88.2%（15/17）,2例留置双J管改行体外冲击波碎石（ESWL）或经皮肾取石术（PCNL）,手术时间60-120 min平均90 min,无输尿管穿孔、撕脱、感染性休克等并发症。3例术后高热,体温38.5-39.2℃,经抗感染治疗3-5 d后体温恢复正常。术后住院时间3-7 d,平均5 d。4周后复查KUB平片或超声并拔除双J管,13例结石排尽,2例下盏结石残余（3-4 mm）,予定期复查。结论在手助托举肋脊角的配合下,组合式输尿管软镜能更容易寻及下组肾盏结石,获得稳定手术视野,具有疗效确切、不增加额外耗材成本、不增加手术风险等优点,值得临床推广。
Objective To evaluate the clinical value of modular fiexible ureteroscopy cooperated with hand-assisted lifting costovertebral angle for calculi in lower renal caliceal. Methods From October 2011 to August 2013, 17 cases of calculi in lower renal caliceal （11-19 mm in diameter; 15 mm average in diameter） were treated by modular flexible ureteroscopy in Xuyi County People＇s Hospital. All patients were under general anesthesia with lithotomy position. A 8.0/9.8 F rigid Ureteroscope was inserted and the double J stents indwelt preoperatively were removed. We introduced a wire into the ureter through the rigid ureteroscope. A 14 F flexible ureteral access sheath was inserted into the ureter along the wire. Then a modular flexible ureteroscope was placed into the ureter and renal pelvis. By lifting the costovertebral angle of the disease side, calculi in lower renal calculi could be more easily to find under the flexible ureteroscope. The stones were fragmentized to less than 3mm by using 200 μm holmium laser （0.6-1.0 J/10-15 Hz）. 5 F double J stent was indwelt regularly and retained for 4-6 weeks postoperatively, and Foley＇s catheter was retained for 2- 7 days. KUB of kidneys, ureter and bladder was performed to detect the results of lithotripsy and the position of double J stent after the surgery. Results 15 operations were performed successfully. The flexible ureteroscope failed to reach lower renal calyces in 2 cases and they received percutaneous nephrolithotomy （PCNL）. The operation time was 60-120 min （average, 90 min）. There were no severe perioperative complications such as ureteral perforation, septicemia or hemorrhage occured. Three patients suffered high fever （38.5-39.2℃） postoperation, and cured by anti-infective therapy after 3-5 days. The patients were discharged from hospital in 3-7 d （average, 5 d） postoperatively. All cases were reviewed with X ray or ultrasonography after 4 weeks, and double J stents were removed simultaneously. The residual stones （diameter 3-4 mm） were observed in 2 cases, which were all located in lower calyx and did not need further treatment. Conclusions Modular flexible ureteroscopy cooperated with hand- assisted costovertebral angle lift is a safe and effective procedure for calculi in lower renal caliceal.
出处
《中华腔镜泌尿外科杂志（电子版）》
2015年第2期26-29,共4页
Chinese Journal of Endourology(Electronic Edition)
关键词
组合式输尿管软镜
手助托举肋脊角
结石
下组肾盏
Modular flexible ureteroscope
Hand-assisted costovertebral angle lift
Calculi, lower renal caliceal
