CAJ | 학술논문

目的探讨软性输尿管镜下钬激光碎石术治疗孤立肾肾结石的安全性及有效性.方法回顾性分析2014年2月至2015年4月采用软性输尿管镜下钬激光碎石术治疗的12例孤立肾肾结石患者资料.其中男7例,女5例;年龄38 ～ 67岁,平均43岁.3例为初诊患者,9例为治疗后残石(2例曾行开放取石、5例曾行经皮肾镜取石术、2例曾行体外冲击波碎石).结石直径0.6 ～3.5 cm,平均1.8 cm.单发结石4例,多发结石8例.结果 12例均顺利进镜并完成钬激光碎石术,一次进镜成功率100％.手术时间54～ 182 min,平均118 min;术中出血量5～30 ml,平均10 ml;住院日4 ～9d,平均4.5d;输尿管支架保留时间2～4周.术后1例患者出现寒战、高热,经积极抗感染治疗后痊愈.1例患者术后出现淡红色肉眼血尿,2d后消失.其余未见严重并发症.术后1个月复查,7例术前血肌酐正常患者术后血肌酐无明显变化,5例术前肾功能不全患者中2例肾功能恢复正常、3例血肌酐值有不同程度的下降.10例患者KUB或CT平扫证实无明显结石残留,一期结石完全清除率为83％(10/12);1例患者残石位于肾下盏,残石直径为4 mm;1例鹿角状结石分3次碎石后无结石残留.结论软性输尿管镜下钬激光碎石术治疗孤立肾肾结石安全、有效,具有创伤小、出血少、并发症少、术后恢复快等优点.
목적 탐토연성수뇨관경하화격광쇄석술치료고립신신결석적안전성급유효성.방법 회고성분석2014년2월지2015년4월채용연성수뇨관경하화격광쇄석술치료적12례고립신신결석환자자료.기중남7례,녀5례;년령38 ～ 67세,평균43세.3례위초진환자,9례위치료후잔석(2례증행개방취석、5례증행경피신경취석술、2례증행체외충격파쇄석).결석직경0.6 ～3.5 cm,평균1.8 cm.단발결석4례,다발결석8례.결과 12례균순리진경병완성화격광쇄석술,일차진경성공솔100％.수술시간54～ 182 min,평균118 min;술중출혈량5～30 ml,평균10 ml;주원일4 ～9d,평균4.5d;수뇨관지가보류시간2～4주.술후1례환자출현한전、고열,경적겁항감염치료후전유.1례환자술후출현담홍색육안혈뇨,2d후소실.기여미견엄중병발증.술후1개월복사,7례술전혈기항정상환자술후혈기항무명현변화,5례술전신공능불전환자중2례신공능회복정상、3례혈기항치유불동정도적하강.10례환자KUB혹CT평소증실무명현결석잔류,일기결석완전청제솔위83％(10/12);1례환자잔석위우신하잔,잔석직경위4 mm;1례록각상결석분3차쇄석후무결석잔류.결론 연성수뇨관경하화격광쇄석술치료고립신신결석안전、유효,구유창상소、출혈소、병발증소、술후회복쾌등우점.
Objective To investigate the safety and efficacy of flexible ureteroscopy combined with holmium laser in treatment of calculi of solitary kidney.Methods A retrospective analysis was carried out on the clinical data of 12 patients with calculi of solitary kidney,who underwent flexible ureteroscopy combined with holmium laser from February 2014 to April 2015.Among them,7 cases were male,5 cases were female,with average age of 43 years (range,39-67).Three patients were new-onset,9 patients were with residual stone after treatment (2 cases after open surgery of stone removal,5 cases after percutaneous nephrolithotripsy,while 2 cases after ESWL treatment).The average stone diameter was 1.8 cm (0.6-3.5 cm).Four cases were single stone,8 cases were multiple stones.Results The ureteroscope and holmium laser lithotripsy was successfully completed in all the 12 patients.The average surgery time was 118 min (54-182 min).Average hospital stays were 4.5 days.Ureteral stent was remained for 2-4 weeks.One patient got chills and fever after operation,and was cured after anti-infection treatment.One patient had gross hematuria after operation,which disappeared 2 days later.No serious complications were seen in other patients.Among 7 cases of patients with normal serum creatinine before operation,no obvious changes of serum creatinine were seen at postoperative 1-month follow-up;among 5 cases of patients with preoperative renal insufficiency,renal function of 2 cases were restored to normal,and the rest 3 cases had different degrees of decline of serum creatinine.KUB or CT scan confirmed that no significant residual stones were found in 10 cases.One-stage stone clearance rate was 83％ (10/12).One patient had residual stones in the subrenal calyx.The residual stone was 4 mm in diameter.Another patient with staghorn calculi received 3 times of lithotripsy and no residual calculi were left.Conclusions Flexible ureteroscopy combined with holmium laser is safe and effective in treatment of calculi of solitary kidney.It has the advantages of small trauma,less bleeding,fewer complications and quicker recovery.