中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2015年
6期
401-404
,共4页
曾国华%李佳胜%赵志健%刘陈黎%刘旸%曾滔%刘永达%陈文忠%吴文起
曾國華%李佳勝%趙誌健%劉陳黎%劉旸%曾滔%劉永達%陳文忠%吳文起
증국화%리가성%조지건%류진려%류양%증도%류영체%진문충%오문기
软性输尿管镜%碎石术,激光%肾结石%结石清除率%并发症
軟性輸尿管鏡%碎石術,激光%腎結石%結石清除率%併髮癥
연성수뇨관경%쇄석술,격광%신결석%결석청제솔%병발증
Flexible ureteroscopy%Lithotripsy,laser%Kidney calculi%Stone free rate%Complications
目的:评价逆行软性输尿管镜下钬激光碎石术治疗肾结石的临床疗效及安全性。方法回顾性收集2013年1—12月采用逆行软性输尿管镜下钬激光碎石术治疗466例肾结石患者的资料。结石最大径为(23±16) mm。评估结石清除率( stone free rate,SFR)、术后并发症发生率和重复治疗率。结果466例手术时间(33.5±18.8) min,住院天数(2.3±2.0) d。一次软性输尿管镜术后SFR为67.6%(315/466)。20例(4.3%)接受了≥2次治疗,466例共行逆行软性输尿管镜下钬激光碎石术493次,平均1.06次/人。术后3个月总SFR为69.5%(324/466)。总并发症发生率为14.4%(67/466),其中输尿管假道形成5例,输尿管穿孔3例,石街形成9例,肾周血肿1例,术后发热50例(10.7%),其中尿脓毒血症16例(3.4%)。当结石最大径≤10、11~20、21~30、31~40、>40 mm时,一次软性输尿管镜术后 SFR 分别为97.0%(65/67)、84.2%(160/190)、63.1%(70/111)、29.2%(14/48)、12.0%(6/50)(P <0.001),术后发热率分别为1.5%(1/67)、9.5%(18/190)、13.5%(15/111)、14.6%(7/48)、18.0%(9/50)(P=0.030),差异均有统计学意义。术前尿白细胞阳性和阴性患者的术后发热率分别为19.3%(27/140)和7.1%(23/326)(P<0.001),术前尿培养阳性和阴性患者的术后发热率分别为22.0%(22/100)和7.7%(28/366)(P<0.001),差异均有统计学意义。结论逆行软性输尿管镜下钬激光碎石术治疗肾结石安全、有效,但随着结石直径增大,SFR降低,术后发热率增高。
目的:評價逆行軟性輸尿管鏡下鈥激光碎石術治療腎結石的臨床療效及安全性。方法迴顧性收集2013年1—12月採用逆行軟性輸尿管鏡下鈥激光碎石術治療466例腎結石患者的資料。結石最大徑為(23±16) mm。評估結石清除率( stone free rate,SFR)、術後併髮癥髮生率和重複治療率。結果466例手術時間(33.5±18.8) min,住院天數(2.3±2.0) d。一次軟性輸尿管鏡術後SFR為67.6%(315/466)。20例(4.3%)接受瞭≥2次治療,466例共行逆行軟性輸尿管鏡下鈥激光碎石術493次,平均1.06次/人。術後3箇月總SFR為69.5%(324/466)。總併髮癥髮生率為14.4%(67/466),其中輸尿管假道形成5例,輸尿管穿孔3例,石街形成9例,腎週血腫1例,術後髮熱50例(10.7%),其中尿膿毒血癥16例(3.4%)。噹結石最大徑≤10、11~20、21~30、31~40、>40 mm時,一次軟性輸尿管鏡術後 SFR 分彆為97.0%(65/67)、84.2%(160/190)、63.1%(70/111)、29.2%(14/48)、12.0%(6/50)(P <0.001),術後髮熱率分彆為1.5%(1/67)、9.5%(18/190)、13.5%(15/111)、14.6%(7/48)、18.0%(9/50)(P=0.030),差異均有統計學意義。術前尿白細胞暘性和陰性患者的術後髮熱率分彆為19.3%(27/140)和7.1%(23/326)(P<0.001),術前尿培養暘性和陰性患者的術後髮熱率分彆為22.0%(22/100)和7.7%(28/366)(P<0.001),差異均有統計學意義。結論逆行軟性輸尿管鏡下鈥激光碎石術治療腎結石安全、有效,但隨著結石直徑增大,SFR降低,術後髮熱率增高。
목적:평개역행연성수뇨관경하화격광쇄석술치료신결석적림상료효급안전성。방법회고성수집2013년1—12월채용역행연성수뇨관경하화격광쇄석술치료466례신결석환자적자료。결석최대경위(23±16) mm。평고결석청제솔( stone free rate,SFR)、술후병발증발생솔화중복치료솔。결과466례수술시간(33.5±18.8) min,주원천수(2.3±2.0) d。일차연성수뇨관경술후SFR위67.6%(315/466)。20례(4.3%)접수료≥2차치료,466례공행역행연성수뇨관경하화격광쇄석술493차,평균1.06차/인。술후3개월총SFR위69.5%(324/466)。총병발증발생솔위14.4%(67/466),기중수뇨관가도형성5례,수뇨관천공3례,석가형성9례,신주혈종1례,술후발열50례(10.7%),기중뇨농독혈증16례(3.4%)。당결석최대경≤10、11~20、21~30、31~40、>40 mm시,일차연성수뇨관경술후 SFR 분별위97.0%(65/67)、84.2%(160/190)、63.1%(70/111)、29.2%(14/48)、12.0%(6/50)(P <0.001),술후발열솔분별위1.5%(1/67)、9.5%(18/190)、13.5%(15/111)、14.6%(7/48)、18.0%(9/50)(P=0.030),차이균유통계학의의。술전뇨백세포양성화음성환자적술후발열솔분별위19.3%(27/140)화7.1%(23/326)(P<0.001),술전뇨배양양성화음성환자적술후발열솔분별위22.0%(22/100)화7.7%(28/366)(P<0.001),차이균유통계학의의。결론역행연성수뇨관경하화격광쇄석술치료신결석안전、유효,단수착결석직경증대,SFR강저,술후발열솔증고。
Objective To evaluate the efficacy and safety of retrograde flexible ureteroscopic lithotripsy ( RFUL) with holmium:YAG laser for the treatment of renal stones with a large series.Methods The data of 466 patients who underwent RFUL with holmium:YAG laser for the treatment of kidney stones between January 2013 and December 2013 were collected.The maximum diameter of stone was 23 ±16 mm.The stone free rate, complications, retreatment rate were evaluated.Results Out of the 466 patients, the mean operative time and postoperative hospital stay were 33.5 ±18.8 min and 2.3 ±2.0 d.The stone free rate was 67.6% ( 315/466 ) after single procedure, which increased to 69.5% ( 324/466 ) via re-treatments after 3 months.The retreatment rate was 4.3%(20/466), with a total of 493 RFUL procedures performed and 1.06 times per patient.There were 67 (14.4%) cases undergoing complications.Five cases had false passage of ureter orifice causing slight ureteral wall injuries.Steinstrasse occurred in 9 cases, ureteral perforation in 3 cases and perirenal hematoma in 1 case.Overall postoperative fever rate was 10.7%(50/466) with urosepsis in 16 cases (3.4%).When the stone size was≤10, 11-20, 21-30, 31-40, and >40 mm, the stone free rates after a single procedure were 97.0% ( 65/67 ) , 84.2% ( 160/190 ) , 63.1%(70/111), 29.2%(14/48), 12.0%(6/50) (P<0.001), and the postoperative fever rates were 1.5%(1/67), 9.5%(18/190), 13.5% (15/111), 14.6% (7/48), 18.0% (9/50), respectively. The postoperative fever rates were 19.3%(27/140) and 7.1%(23/326) (P<0.001) in the patient with positive and negative preoperative urine leukocyte, and 22.0% ( 22/100 ) and 7.7% ( 28/366 ) ( P <0.001) in patients with positive and negative preoperative urine culture.Conclusions RFUL with holmium:YAG laser is a safe and effective treatment for kidney stones.The postoperative fever rate would increase and stone free rate would reduce with the increased stone size.