国际泌尿系统杂志
國際泌尿繫統雜誌
국제비뇨계통잡지
INTERNATIONAL JOURNAL OF UROLOGY AND NEPHROLOGY
2014年
1期
21-23
,共3页
叶剑锋%杨嗣星%汪前亮%刘鸿标
葉劍鋒%楊嗣星%汪前亮%劉鴻標
협검봉%양사성%왕전량%류홍표
肾结石%激光,固体%输尿管镜
腎結石%激光,固體%輸尿管鏡
신결석%격광,고체%수뇨관경
Kidney Calculi%Lasers,Solid-State%Ureteroscopes
目的 探讨输尿管软镜钬激光碎石术在治疗孤立肾肾结石中的临床应用价值.方法 回顾分析本院使用奥林巴斯电子输尿管软镜钬激光碎石处理的39例孤立肾肾结石患者的临床资料,其中肾盂肾盏多发性结石20例,孤立肾感染性结石4例,肾盏憩室内结石10例,肾盏嵌顿结石4例,多发性肾乳头黏膜下钙化1例.术中先行输尿管硬镜镜检,留置斑马导丝并放置F12～ 14输尿管扩张鞘后经鞘或直接沿斑马导丝入镜.软镜进入肾盂后首先镜下观察肾盂及上、中、下各盏并定位结石,根据结石位置选用365μm或200μm光纤,功率选择在0.5～1J、15～ 30Hz范围,以表面蚕蚀、周缘穿孔、中央穿孔等方法将结石完全粉碎2mm以内,若患者留置输尿管鞘,则以冲水引流、套石蓝取石等方法将结石取出或部分取出.所有患者常规留置DJ管2周,术后第1d拔除导尿管,术后2周拔除DJ管,术后4周常规复查泌尿系平片(KUB)或双肾CT平扫,评估结石排净率.残留结石≥4mm为有临床意义的结石残留.结果 本组39例患者34例成功置放输尿管鞘,输尿管镜鞘放置成功率87.2％,进镜成功率100％,术中寻找结石成功率100％.一期手术成功碎石33例,结石均排尽或残余结石＜4mm,无需进一步处理.另3例下盏憩室内结石,2例下盏结石,1例肾乳头黏膜下钙化结石/残石均≥4mm,辅助体外冲击波碎石或2期输尿管软镜手术.结论 输尿管软镜对比经皮肾镜,具有微创安全、手术并发症少的特点,而且几乎可以达到肾内集合系统所有位置,结合钬激光适合治疗各类孤立肾肾结石.
目的 探討輸尿管軟鏡鈥激光碎石術在治療孤立腎腎結石中的臨床應用價值.方法 迴顧分析本院使用奧林巴斯電子輸尿管軟鏡鈥激光碎石處理的39例孤立腎腎結石患者的臨床資料,其中腎盂腎盞多髮性結石20例,孤立腎感染性結石4例,腎盞憩室內結石10例,腎盞嵌頓結石4例,多髮性腎乳頭黏膜下鈣化1例.術中先行輸尿管硬鏡鏡檢,留置斑馬導絲併放置F12～ 14輸尿管擴張鞘後經鞘或直接沿斑馬導絲入鏡.軟鏡進入腎盂後首先鏡下觀察腎盂及上、中、下各盞併定位結石,根據結石位置選用365μm或200μm光纖,功率選擇在0.5～1J、15～ 30Hz範圍,以錶麵蠶蝕、週緣穿孔、中央穿孔等方法將結石完全粉碎2mm以內,若患者留置輸尿管鞘,則以遲水引流、套石藍取石等方法將結石取齣或部分取齣.所有患者常規留置DJ管2週,術後第1d拔除導尿管,術後2週拔除DJ管,術後4週常規複查泌尿繫平片(KUB)或雙腎CT平掃,評估結石排淨率.殘留結石≥4mm為有臨床意義的結石殘留.結果 本組39例患者34例成功置放輸尿管鞘,輸尿管鏡鞘放置成功率87.2％,進鏡成功率100％,術中尋找結石成功率100％.一期手術成功碎石33例,結石均排儘或殘餘結石＜4mm,無需進一步處理.另3例下盞憩室內結石,2例下盞結石,1例腎乳頭黏膜下鈣化結石/殘石均≥4mm,輔助體外遲擊波碎石或2期輸尿管軟鏡手術.結論 輸尿管軟鏡對比經皮腎鏡,具有微創安全、手術併髮癥少的特點,而且幾乎可以達到腎內集閤繫統所有位置,結閤鈥激光適閤治療各類孤立腎腎結石.
목적 탐토수뇨관연경화격광쇄석술재치료고립신신결석중적림상응용개치.방법 회고분석본원사용오림파사전자수뇨관연경화격광쇄석처리적39례고립신신결석환자적림상자료,기중신우신잔다발성결석20례,고립신감염성결석4례,신잔게실내결석10례,신잔감돈결석4례,다발성신유두점막하개화1례.술중선행수뇨관경경경검,류치반마도사병방치F12～ 14수뇨관확장초후경초혹직접연반마도사입경.연경진입신우후수선경하관찰신우급상、중、하각잔병정위결석,근거결석위치선용365μm혹200μm광섬,공솔선택재0.5～1J、15～ 30Hz범위,이표면잠식、주연천공、중앙천공등방법장결석완전분쇄2mm이내,약환자류치수뇨관초,칙이충수인류、투석람취석등방법장결석취출혹부분취출.소유환자상규류치DJ관2주,술후제1d발제도뇨관,술후2주발제DJ관,술후4주상규복사비뇨계평편(KUB)혹쌍신CT평소,평고결석배정솔.잔류결석≥4mm위유림상의의적결석잔류.결과 본조39례환자34례성공치방수뇨관초,수뇨관경초방치성공솔87.2％,진경성공솔100％,술중심조결석성공솔100％.일기수술성공쇄석33례,결석균배진혹잔여결석＜4mm,무수진일보처리.령3례하잔게실내결석,2례하잔결석,1례신유두점막하개화결석/잔석균≥4mm,보조체외충격파쇄석혹2기수뇨관연경수술.결론 수뇨관연경대비경피신경,구유미창안전、수술병발증소적특점,이차궤호가이체도신내집합계통소유위치,결합화격광괄합치료각류고립신신결석.
Objectives To explore the clinical value of digital flexible ureteroscopy with holmium laser lithotripsy in the treatment of renal calculi in solitary kidneys.Methods Date of 39 cases of renal calculi in solitary kidneys treated with Olympus e-flexible ureteroscope with holmium laser lithotripsy in our department were retrospectively analyzed.20 of the cases were multiple stones in the renal pelvis and calyx,4 were solitary kidney infection calculi,1 o were calyx diverticulum stones,4 were impacted calycolithiasis,and 1 were multiple submucosal calcification.Ureteroscopy was conducted.Guide wires were indwelt and F12-14 ureteral dilatation sheath was placed.After the flexible ureteroscope entered the pelvis,renal pelvis and upper,middle and lower calyx were observed to locate the calculi.365 um or 200 um fiber was chosen according to stone location,and the power ranged between 0.5 ～ 1Jand 15 ～ 30Hz.Stones were completely smashed to 2mm.If ureteral sheath was placed,stone could be removed or partially removed with flush drainage or stone-bag.Double-J tube was indwelt in all patients for two weeks.The first day after the operation catheter was removed.4 weeks after the surgery,KUB or CT was performed to assess the stone excretion rate.Results 34 of 39 cases(87.2％) had successful placement of ureteral sheaths,and all cases had ureteroscope entered successfully and located the calculi.33cases had no stone residual or stone residuals ＜4mm after the first operation.Conclusions Providing clear vision,digital flexible ureteroscope is safe and minimal invasive.Combined with holmium laser,it can be used in the treatment of all types of renal calculi in solitary kidneys.
