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目的:分析组合式输尿管软镜钬激光碎石术治疗肾结石术后结石残留的原因,探讨防治措施。方法:回顾性分析我院2014年1月至2015年12月128例肾结石患者行组合式输尿管软镜钬激光碎石术后结石残留情况,分类总结术后结石残留原因。结果:实施手术128例,18例患者术后3个月后复查提示有结石残留,需进一步处理(清石率86%,术后残石率14%)。其中结石总体直径<2 cm组5例,结石总体直径≥2 cm组13例。结石位于肾下盏肾盂肾盏夹角偏小,因输尿管软镜弯曲角度原因无法完全碎除结石至结石残留5例。因术中误损伤肾脏黏膜至出血视野欠清而结石残留2例。因肾内集合系统解剖异常导致术后结石残留2例,其中1例为肾内型分支型肾盂伴有开放手术史,1例为重复肾畸形。结论:结石数量过多、结石体积过大、结石位于肾下盏肾盂肾盏夹角偏小、变异的肾内集合系统、术者操作不熟练是组合式输尿管软镜钬激光碎石术后结石残留的主要原因。
OBJECTIVE: To analyze the causes of ureteral calculi combined ureteroscopic holmium laser lithotripsy in the treatment of postoperative calculus of kidney stones, and to discuss the prevention and treatment measures. Methods: A retrospective analysis of 128 cases of renal stones in our hospital from January 2014 to December 2015 in combination with ureteroscopic holmium laser lithotripsy residual stones, the classification of postoperative causes of residual stones. Results: The operation of 128 cases, 18 patients after 3 months after the review showed that residual stones need further treatment (clear rate of 86%, postoperative residual stone rate of 14%). The total diameter of stones <2 cm group of 5 cases, the total diameter of stones ≥ 2 cm group of 13 cases. Stones located in the lower renal calyx calyx angle is small, due to the reasons for the bending angle of the ureteroscope can not completely remove the stone to the residual stones in 5 cases. Due to intraoperative misdiagnosis of the renal mucosa to bleeding due to lack of clear and residual stones in 2 cases. Two cases of postoperative residual stones were found due to anatomical abnormalities of the renal collecting system, of which 1 had a history of open surgery for the intrarenal-type branch-type renal pelvis and 1 had repeated renal deformities. Conclusion: The number of stones is too large, the volume of stones is too large, the stones in the lower renal pelvis and kidney calyx angle is small, the variation of the renal collecting system, the surgeon is not skilled in combination ureteroscopic ureteroscopic holmium laser lithotripsy The main reason for the residue.