摘要
目的 探讨硕通镜治疗上尿路结石的临床疗效及安全性.方法 回顾性分析2014年7月至2017年2月采用硕通镜下钬激光碎石术治疗的823例上尿路结石患者的临床资料.男470例,女353例.年龄19 ～ 86岁（52.1±12.7）岁.结石最大径1.4～5.3 cm（2.8±1.8）cm.根据结石最大径分组,≤2.0 cm组112例（13.6％）,2.1 ～3.0 cm组395例（48.0％）,3.1 ～4.0 cm组257例（31.2％）,＞4.0 cm组59例（7.2％）.肾结石508例（61.7％）,输尿管上段结石196例（23.8％）,肾结石合并输尿管上段结石119例（14.5％）.手术均采用全麻,患者取截石位.在F3输尿管支架管引导下置入输尿管通道鞘,硕通镜沿鞘上行至肾盂、肾盏寻找到结石后,钬激光碎石,并用负压吸引器清石.统计分析结石清除率（SFR）和术后并发症情况.结果 本研究823例患者中,一期手术663例,二期手术160例.手术时间23 ～ 145 min（74.8±35.3） min.术后住院时间1～5d（1.9±0.8）d.术后1d的SFR为75.6％（622/823）,术后1个月SFR为83.8％（690/823）.≤2.0 cm组、2.1～3.0 cm组、3.1 ～4.0 cm组、＞4.0 cm组术后1d的SFR分别为89.3％ （100/112）、82.5％（326/395）、61.1％ （157/257）、52.5％ （31/59）;术后1个月SFR分别为95.5％ （107/112）、87.6％（346/395）、72.0％（185/257）、61.0％ （36/59）,差异有统计学意义（均P＜0.05）.823例术后91例（11.1％）发热,16例（1.9％）输尿管损伤,5例（0.6％）出现严重血尿,10例（1.2％）发生石街,3例（0.4％）发生肾周血肿,经相应处理后均治愈.结论 硕通镜治疗上尿路结石清石率高、安全性好.
Objective To investigate the efficacy and safety of Shuo Tong ureteroscopy in the treatment of upper ureteric stones.Methods The data of 832 patients,who underwent Shuo Tong ureteroscopy combined with holmium laser for the treatment of upper ureteric stones were collected between July 2014 and February 2017.The patients accepted general anesthesia under lithotomy position.After dilating the ureter,a ureteral access sheath was inserted along the guide wire.Finally,stones were broken and clean up by Shuo Tong ureteroscope.According to the stone size,823 patients were divided into ≤2.0 cm group （n=112,13.6%）,2.1-3.0 cm group （n =395,48.0%）,3.1-4.0 cm group （n =257,31.2%）,〉 4.0 cm group （n =59,7.2%）The stone free rate（SFR） and post-operative complications were observed.Results Among 983 operations,663 cases accepted one-stage operations and 160 cases accepted second stage operations.the operative time and postoperative hospital stay were 23-145 min（mean 74.8 ± 35.3） and 1-5 days（mean 1.9 ±0.8）,respectively.The SFR in the first day and one month after operation was 75.6% and 83.8%,respectively.The stone free rate in each group were 89.3%,82.5%,61.1%,52.5% at first day after operation respectively（P 〈 0.05）.While,the SFR after one month were 95.5%,87.6%,72.0%,61.0% in each group,respectively（P 〈 0.05）.Fever rate after operation was 11.1%,ureteral injury rate was 1.9%,severe hematuria rate was 0.6%,stone street formation rate was 1.2%,perirenal hematoma rate was 0.4%.All patients were improved after conventional treatment.Conclusion Shuo Tong ureteroscopy is a safe treatment with high stone free rate for upper ureteric stones.
作者
王树声
翁湘涛
周均洪
甘澍
廖芝健
唐炎权
古炽明
邹乾明
Wang Shusheng Weng Xiangtao Zhou Junhong Gan Shu Liao Zhijian Tang Yanquan Gu Chiming Zou Qianming(Department of Urology, Traditional Chinese Medicine Hospital of Guangdong Province, Guangzhou 510030, China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第9期671-674,共4页
Chinese Journal of Urology
关键词
硕通镜
上尿路结石
结石清除率
并发症
Shuo Tong ureteroscopy
Upper ureteric stones
Stone free rate
Complication
