CAJ | 학술논문

目的探讨软性输尿管镜下钬激光碎石术治疗先天性盆腔异位肾结石的疗效和安全性. 方法回顾性分析2007年1月至2012年4月收治的11例先天性盆腔异位肾结石患者的临床资料.男6例,女5例.年龄37～52岁,平均47岁.多发结石5例,单发肾孟结石3例,单发下盏结石3例;结石负荷1.8～3.7 cm,平均2.3 cm,单个结石最大径2.6 cm.7例曾接受ESWL;1例曾接受ESWL和PCNL各1次,仍有较多结石残留.术前2周于膀胱镜下留置双J管.静脉复合麻醉下行软性输尿管镜下钬激光碎石术,术中沿软镜输送鞘逆行进镜,寻及结石后用钬激光碎石,碎石功率≤20 W(0.6～1.0 J/10～20 Hz).结石碎块用套石篮取出.术后留置双J管2周. 结果本组11例均顺利放置软镜鞘,一次进镜成功率100％.手术时间31～87 min,平均62 min.术中无大出血、输尿管或肾盂穿孔、输尿管撕脱等并发症发生.术后第1日复查,3例多发结石有部分残留,残石均位于下盏,因无梗阻且无症状,予保守观察.11例均于手术次日出院.术后3个月复查均无尿路梗阻.结论软性输尿管镜下钬激光碎石术治疗先天性盆腔异位肾结石是一种安全、有效、微创的治疗方法.
목적 탐토연성수뇨관경하화격광쇄석술치료선천성분강이위신결석적료효화안전성. 방법 회고성분석2007년1월지2012년4월수치적11례선천성분강이위신결석환자적림상자료.남6례,녀5례.년령37～52세,평균47세.다발결석5례,단발신맹결석3례,단발하잔결석3례;결석부하1.8～3.7 cm,평균2.3 cm,단개결석최대경2.6 cm.7례증접수ESWL;1례증접수ESWL화PCNL각1차,잉유교다결석잔류.술전2주우방광경하류치쌍J관.정맥복합마취하행연성수뇨관경하화격광쇄석술,술중연연경수송초역행진경,심급결석후용화격광쇄석,쇄석공솔≤20 W(0.6～1.0 J/10～20 Hz).결석쇄괴용투석람취출.술후류치쌍J관2주. 결과 본조11례균순리방치연경초,일차진경성공솔100％.수술시간31～87 min,평균62 min.술중무대출혈、수뇨관혹신우천공、수뇨관시탈등병발증발생.술후제1일복사,3례다발결석유부분잔류,잔석균위우하잔,인무경조차무증상,여보수관찰.11례균우수술차일출원.술후3개월복사균무뇨로경조.결론 연성수뇨관경하화격광쇄석술치료선천성분강이위신결석시일충안전、유효、미창적치료방법.
Objective To evaluate the efficacy and safety of the flexible ureteroscopy (FURS) with holmium laser lithotripsy in the management of stones in ectopic pelvic kidney (PK).Methods We retrospectively reviewed the records of 11 patients,ranged from 37-52 years old,who were underwent FURS with holmium laser for PK stones from January 2007 to April 2012.Three cases had solitary stones in renal pelvis,3 cases had solitary stones at lower calyx and multiple stones were found in 5 cases.Mean size of stone was 2.3 cm (ranged 1.8-3.7 cm).One case had history of ESWL and PCNL before surgery with unsatisfied result and 7 cases were underwent ESWL with poor outcome.The double J stent was placed into the ureter two weeks before the operation.Under the general anesthesia,the ureteral access sheath was placed firstly during operation.Then,flexible ureteroscopy was inserted into the renal pelvis through ureteral access sheath.Holmium laser was used to perform the procedure with the power less than 20 W (0.6-1.0 J/10-20 Hz).The stone fragments were taken out by stone baskets and double-J stent was set at the end of the procedure for additional two weeks.Results The successive rate of the ureteroscopic insertion was 100％.The average operation time was 62 min (ranged 31-87 min).No severe complications such as heavy bleeding,perforation or ureteral avulsion occurred.Small stone fragments were found in 3 cases.All of them located in the lower calyx.Since no one complained about the upper urinary obstruction or related symptoms,conservative observation was considered.All patients discharged the day after the operation.Within three months follow-up,no sign of urinary obstruction was found.Conclusions FURS with holmium laser is a safe,effective and minimally invasive technique.It could be the best option in the management of renal calculi in ectopic pelvic kidney.