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目的探讨采用F8组合式输尿管软镜处理<2cm上尿路结石的临床价值。方法 2010年11月至2012年8月收住上海交通大学医学院附属新华医院的上尿路结石患者117例,男性71例、女性46例,年龄20岁～86岁,平均(49.7±13.9)岁,单发结石96例,多发结石21例。结石平均直径(1.19±0.34)cm。左侧结石61例,右侧56例。其中有22例患者事先行输尿管镜下留置D-J管2～8周(输尿管狭窄13例,尿路感染7例,肾功能不全2例)。在全麻或脊麻下,患者取截石位,先置入F8/9.8输尿管硬镜进入输尿管内行直视下扩张。输尿管上段结石尽量用硬镜在输尿管内原位碎石。退出输尿管硬镜,沿导丝置入F12/14软镜输送鞘,随后置入F8“铂立”软镜进入肾盂内进行检查和钬激光碎石,激光功率1.0J,频率10～20Hz。术后常规留置F6D-J管4周,留置导尿管1～7d。术后第1天行腹部平片(KUB)检查碎石情况及D-J管位置,部分病例术后2～4周复查KUB,如发现残留结石直径>6mm的患者进一步结合体外冲击波碎石术(ESWL)治疗。结果 103例病例均顺利碎石,手术时间25～85min,平均(46±14)min,术中出血量少。术后有4例病例出现术后高热,经抗炎治疗后治愈;无明显的输尿管损伤穿孔、败血症等情况。单次结石清除率为88%(103/117),结合ESWL后结石清除率达95.7%(112/117)。结论 F8组合式输尿管软镜处理上尿路结石安全、方便,疗效可靠。
Objective To investigate the clinical value of F8 combined ureteroscopy in the treatment of upper urinary tract calculi less than 2 cm. Methods From November 2010 to August 2012, 117 patients with upper urinary tract stones admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine were enrolled. Among them, 71 were male and 46 were female, ranging in age from 20 to 86 years (mean, 49.7 ± 13.9) Aged, single stone in 96 cases, multiple stones in 21 cases. The average diameter of stones (1.19 ± 0.34) cm. The left side of the stone in 61 cases, 56 cases of right. Twenty-two of these patients underwent ureteroscopy for 2 to 8 weeks of prior D-J catheterization (ureteral stricture in 13, urinary tract infection in 7, and renal insufficiency in 2). In general anesthesia or spinal anesthesia, patients take lithotomy position, first into the F8 / 9.8 ureteroscopy into the ureter under direct line of expansion. Upper ureteral stones as hard as possible in situ ureteral lithotripsy. Exit the ureteroscope, place it in the F12 / 14 soft lens sheath along the guide wire, then insert the F8 “Platinum ” soft mirror into the renal pelvis for examination and holmium laser lithotripsy. The laser power is 1.0J and the frequency is 10 ~ 20Hz . Postoperative routine indwelling F6D-J tube 4 weeks, indwelling catheter 1 ~ 7d. On the first postoperative day, KUB was performed to check the lithotripsy and the position of the DJ tube. In some cases, KUB was reviewed 2 to 4 weeks after operation. Patients with residual stones> 6 mm in diameter were further treated with extracorporeal shock wave lithotripsy (ESWL )treatment. Results The 103 cases were successfully gravel, operation time 25 ~ 85min, an average of (46 ± 14) min, less blood loss. Postoperative 4 cases of postoperative fever, after anti-inflammatory treatment was cured; no obvious ureteral injury perforation, sepsis and so on. The single stone clearance rate was 88% (103/117), and stone clearance was 95.7% (112/117) after ESWL. Conclusion F8 combined ureteroscopic treatment of upper urinary tract stones safe, convenient and reliable.