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目的探讨输尿管软镜对直径>2 cm肾结石处理的安全性、有效性及临床应用价值。方法回顾性分析2012年8月-2014年7月,采用输尿管软镜联合钬激光碎石术处理经选择直径>2 cm的肾结石15例。术前留置输尿管支架管1~2周,术中使用F8.0/9.8输尿管硬镜探查、扩张患侧输尿管,置入超滑导丝后留置输尿管软镜鞘,引入输尿管软镜进行钬激光碎石,较大、影响视野的结石碎片用套石网篮取出。结果一次性进镜成功率100%,无患者因发生术中严重并发症而停止手术。手术时间50~125 min,平均75 min。无输尿管穿孔、脓肾及急性肾功能不全等并发症发生。术后4例出现高热,经积极抗感染治疗后好转。术后2 d复查腹部X线平片结石清除率73.3%(11/15);术后4周随访,结石清除率86.7%(13/15);1例少量残留结石碎片停留于输尿管中下段,予以输尿管硬镜碎石后排出;1例肾脏残余结石二期输尿管软镜下钬激光碎石。结论经输尿管软镜碎石术治疗经选择的直径>2 cm肾结石是安全、有效的,可以作为有效方法进行推广使用。
Objective To investigate the safety, efficacy and clinical value of ureteroscopic treatment of renal calculi> 2 cm in diameter. Methods Retrospective analysis From August 2012 to July 2014, 15 cases of kidney stones of more than 2 cm diameter were selected by ureteroscopic combined with holmium laser lithotripsy. Preoperative ureteral stent placement indwelling for 1 to 2 weeks, intraoperative use of F8.0 / 9.8 ureteroscopy exploration, expansion of ipsilateral ureteral, ultra-slip guide wire placed ureteroscopy sheath, the introduction of ureteroscopic holmium laser broken Stone, larger, affecting the vision of stone fragments removed with a stone basket. Results One-time success rate of 100% into the mirror, no patient due to serious intraoperative complications and surgery. The operation time was 50 to 125 minutes with an average of 75 minutes. No ureter perforation, pus kidney and acute renal insufficiency and other complications. After 4 cases of high fever, after active anti-infective therapy improved. The rate of stone removal was 73.3% (11/15) on postoperative day 2, and the rate of stone removal was 86.7% (13/15) at 4 weeks postoperatively. One case of small residual stone remained in the middle and lower ureter, After ureteroscopic lithotripsy, 1 case of renal residual calculus ureteroscopic holmium laser lithotripsy. Conclusion The ureteroscopic soft lithotripsy for the treatment of selected> 2 cm diameter stones is safe and effective and can be used as an effective method.