CAJ | 학술논문

目的：探讨电子输尿管软镜下钬激光碎石术处理大于2.0 cm肾结石的疗效及安全性。方法2012年10月至2013年12月我院采用电子输尿管软镜(Olympus V5)下钬激光碎石术治疗直径≥2.0 cm的肾结石的43例患者。所有患者术前预先留置F5双J管1~2周。术中先用F8.0/9.8输尿管硬镜留置导丝,沿导丝置入输尿管软镜输送鞘,再引入输尿管软镜进行钬激光碎石,尽可能将结石粉末化,直径大于3 mm的结石碎屑尽可能用套石网篮取出。结果43例患者结石长径2.0~3.2 cm,平均2.4 cm。一次进镜成功率95.3%(41/43),2例因输尿管腔狭小未能一期行输尿管软镜手术。手术时间35~120 min,平均68 min。术后3例出现寒战、发热等感染症状,经积极抗感染治疗后好转,无严重出血等并发症。术后住院2~4 d,平均3.2 d。术后12周随访,结石清除率86%(37/43)。结论电子输尿管软镜钬激光碎石术治疗≥2.0 cm肾结石,安全、有效,特别适用于高龄、孤立肾、既往有切开取石或经皮肾镜术后复发肾结石的患者。
목적：탐토전자수뇨관연경하화격광쇄석술처리대우2.0 cm신결석적료효급안전성。방법2012년10월지2013년12월아원채용전자수뇨관연경(Olympus V5)하화격광쇄석술치료직경≥2.0 cm적신결석적43례환자。소유환자술전예선류치F5쌍J관1~2주。술중선용F8.0/9.8수뇨관경경류치도사,연도사치입수뇨관연경수송초,재인입수뇨관연경진행화격광쇄석,진가능장결석분말화,직경대우3 mm적결석쇄설진가능용투석망람취출。결과43례환자결석장경2.0~3.2 cm,평균2.4 cm。일차진경성공솔95.3%(41/43),2례인수뇨관강협소미능일기행수뇨관연경수술。수술시간35~120 min,평균68 min。술후3례출현한전、발열등감염증상,경적겁항감염치료후호전,무엄중출혈등병발증。술후주원2~4 d,평균3.2 d。술후12주수방,결석청제솔86%(37/43)。결론전자수뇨관연경화격광쇄석술치료≥2.0 cm신결석,안전、유효,특별괄용우고령、고립신、기왕유절개취석혹경피신경술후복발신결석적환자。
Objective To investigate the efficacy and safety of electronic flexible ureteroscope Holmium laser lithotripsy in the treatment of kidney stones larger than 2. 0 cm. Methods From October 2012 to December 2013,43 cases of kidney stones larger than 2. 0 cm in diam-eter were treated with holmium laser lithotripsy under electronic flexible ureteroscope. A double-J stent was indwelled in ureter for 1~2 weeks before operation in each patient. Ureteral catheter guide wire was firstly put into the ureter with F8. 0/9. 8 semi-rigid ureteroscope,and the ac-cess sheath was put along the wire. Then,the electronic flexible ureteroscope(Olympus V5) was introduced into the pelvis. Stones were frag-mented with holmium laser,and greater than 3 mm crushed stones were removed with a set of stone basket. Results The diameter of the stones of the 43 patients ranged from 2~3. 2 cm,with an average of 2. 4 cm. The operation time ranged from 35~120 min,with an average of 68 min. Three patients complicated with chills,fever and other symptoms of infection,who were improved by active anti-infective treatment. No serious complications occurred. Postoperative hospital stay was 2~4 d,with an average of 3. 2 d. After 12 weeks of follow-up,stone clearance rate was 86% (37/43). Conclusion It is safe and efficacy to treat kidney stones larger than 2. 0 cm with electronic flexible ureteroscope, especially for the elderly,solitary kidney,and patients with a previous incision or percutaneous nephrolithotomy.