论文部分内容阅读
目的 探讨利用电子输尿管软镜联合钬激光碎石术治疗单纯性肾下盏结石的治疗效果并分析术后结石残留的影响因素.方法 回顾性分析研究2016年6月—2018年12月泌尿外科利用电子输尿管软镜钬激光碎石术治疗的38 例单纯性肾下盏结石患者的临床资料.结石直径1～2 cm.术后1 个月予以复查泌尿系B超及CT,残余结石直径≥4 mm为有临床意义的结石残余.分析术中寻石成功率、术后并发症发生率、结石再次治疗率、结石清除率及其可能的影响因素.结果 38 例手术均顺利实施完成,术中寻石成功率为100%,肾下盏结石清除率达到81.58%(31/38),结石再次治疗率18.42%(7/38),术后平均住院时间3～7 d,3 例患者出现术后发热,1 例患者出现严重血尿,经对症治疗后均好转痊愈.无临床严重并发症如输尿管穿孔、输尿管撕脱及尿脓毒血症等发生.结石大小、结石CT值、肾盂积水、肾下盏解剖结构等多种影响因素均可能造成术后结石残留.结论 电子输尿管软镜钬激光碎石术处理1～2 cm肾下盏结石具备微创、安全可靠及有效的优势,是值得推广的肾下盏结石腔内手术方式,但结石残留发生率仍与多种影响因素相关.“,”Objective To evaluate the clinical efficacy of digital flexible ureteroscope combined with holmium laser lithotripsy in the treatment of subrenal calyx calculus, and analyze the influencing factors of postoperative residual stones. Methods Review of the clinical data of 38 patients of subrenal calyx calculus who were treated with digital flexible ureteroscopic lithotripsy from June 2016 to December 2018. The stone size was 1-2 cm. B-ultrasonography and CT were performed to evaluate the effects one month after the operation. Residual stones ≥ 4 mm were considered as clinical significance of residual stone. The clinical data included the stone detection rate, stone free rate (SFR), stone retreatment rate and occurrence of complications. Results The operations were performed successfully in all the 38 patients. The stone detection rate was 100%, SFR of subrenal calyx calculus was 81.58% (31/38), stone retreatment rate was 18.42% (7/38), the hospitalization time was 3-7 days. 3 cases with postoperative fever were cured after anti-inflammatory treatment. 1 case with severe gross hematuria after operation was also cured successfully. No severe complications such as urosepsis, ureteral perforation and ureteral avulsion occurred. The influencing factors for residual stones after treatment of flexible ureteroscope maybe included lower renal calyceal anatomic structure, stone size, CT value, degree of hydronephrosis and etc. Conclusion Digital flexible ureteroscopic lithotripsy is a safe, effective and minimally traumatic procedure for subrenal calyx calculus with diameter between 1-2 cm, so it should be popularized, but the incidence of residual stones is closely related to many influencing factors.