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组合式输尿管软镜联合钬激光治疗肾结石72 例
段先忠1,2
1.(1)保山市第二人民医院泌尿外科,云南 保山 678000;2.2)昆明医科大学第二附属医院泌尿外科,云南 昆明 650101)
摘要:
[摘要]目的 探讨组合式输尿管软镜联合钬激光治疗肾结石的临床应用价值.方法 于2013年11月至2015年6月应用德国铂立组合式输尿管软镜联合钬激光治疗肾结石72 例, 结石直径10~45 mm,平均16mm.20例术前留置双J管3~4周,术中应用200 μm钬激光光纤设置功率1.5 J /10~20 Hz(15~30 W)碎石,术后1个月复查KUB.结果 72例中56例成功置入F12软镜输送鞘,16例置入输送鞘失败,其中6例在导丝引导下将软镜置入肾盂肾盏成功碎石,6例改mPCNL治疗,4例留置双J管4周后二期行软镜碎石成功.2例单发肾下盏结石,4例多发结石的肾下盏结石术中无法寻及,留置双J管后行ESWL治疗,结石寻及率90.9%(60/66).术后1个月复查KUB,成功碎石的60例患者中4例单发下盏结石及1例鹿角形结石残留,其余患者结石均清除干净,单次手术结石排净率为91.7%(55/60),结石排净率95%的可信度区间为84.84%~98.56%.碎石时间20~150 min,平均50 min.术中出现尿外渗和腹腔积液1例,无大出血、输尿管撕脱或穿孔、尿路感染等严重并发症,术后平均住院时间3 d.结论 组合式输尿管软镜操作方便、使用成本低,联合钬激光治疗肾结石具有微创、安全、效果好、并发症少等优点,值得临床推广应用.
关键词:  [关键词]组合式输尿管软镜  钬激光  肾结石
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基金项目:[基金项目]云南省首批基层专家工作站资助项目(2014-300-28)
Modular Flexible Ureteroscope Combined with Holmium Laser Lithotripsy in the Treatment of Renal Calculi: Report of 72 Cases
DUAN Xian-zhong1,2
1.(1)Dept. of Urology,The Second People’s Hospital of Baoshan. Baoshan,Kunming Yunnan 678000;2) Dept. of Urology,The Second Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101,China)
Abstract:
[Abstract]Objective To explore the clinical value of modular flexible ureteroscope combined with holmium laser lithotripsy in the treatment of renal calculi. Methods From November 2013 to June 2015,72 patients with renal calculi were treated by modular flexible ureteroscope(Polydiagnost,German)combined with holmium laser lithotripsy. The diameter of stones was 10-45 mm,16 mm on average. Twenty cases were indwelling double J tube for 3-4 weeks before operation. 200 μm holmium laser fiber was used and laser power was set to 1.5J/10-20Hz(5 to 30 W). KUB examination was performed 1 month after operation.Results Seventy-two cases were treated. F12 ureter sheath was successfully inserted into ureter in 56 cases, and failed in 16 cases. In 6 cases,modular flexible ureteroscope was put into renal pelvis and calices with the help of guidewire,and stones were successfully treated. MPCNL was selected to treat calculi in 6 cases,and modular flexible ureteroscope lithotripsy was successfully applid after double J tubes were placed for 4 weeks in 4 cases. Lower renal calyceal calculi were not found in 6 cases cases,ESWL was selected to treat these cases after double J tube indwelling. The stone found rate was 90.9%(60/66). KUB was examined 1 month after operation. Residul stones were found in 5 cases. Total free rate was 91.7%(55/60)through single operation. Calculus lines up clean the zone leading 95% credibilities is 84.84%-98.56%. The time of lithotripsy was 20-150 min,and the average time was 50 min. During operation, perfusion fluid extravasation and peritoneal effusion were found in 1 case. No severe complications such as heavy bleeding, ureteral avulsion or perforation, urinary tract infection were found in all cases. The average hospitalization was 3 days after modular flexible ureteroscope.Conclusions Modular flexible ureteroscope is easy to operate, and the usage cost is lower. The technology, modular flexible ureteroscope combined with holmium laser lithotripsy for treatment of renal calculi, has the advantages of minimal invasion,high safety and effectiveness, less complications. So this technology is worthy of clinical popularization and application.
Key words:  [Key words]Modular flexible ureteroscope  Holmium laser  Renal calculi