输尿管软镜钬激光碎石取石术治疗大于2 cm上尿路结石的疗效及安全性分析

Efficacy and safety of flexible ureteroscopy retrograde surgery for urinary stones over 2 cm

摘要:

目的：评价输尿管软镜钬激光碎石取石术治疗大于2 cm上尿路结石的疗效与安全性。方法：回顾性分析2013年5月至2016年12月四川大学华西医院行输尿管软镜钬激光碎石取石术治疗的大于2 cm的上尿路结石患者272例，采集年龄、性别、体质指数、结石部位、结石大小、手术时间、碎石时间、结石清除率、并发症发生情况等信息，并对手术的安全性和有效性进行评价。结果：共纳入患者272例，其中男性188例、女性84例，中位年龄46.5岁。其中肾结石254例（93.4%）、输尿管上段结石18例（6.6%），且有6例（2.2%）输尿管结石合并肾结石。结石平均累计最大径线（cumulative stone diameter，CSD）为（34.2±9.7） mm。手术成功率为99.3%，平均手术时间为（44.17±20.47） min，平均碎石时间为（28.58±20.47） min，平均住院时间为（7.3±2.3） d。30 d结石清除率为90.5%，90 d结石清除率为93.8%。多因素logistic回归分析显示肾积水是术后结石清除率的独立影响因素（95%CI=5.31~7 133.90，P=0.004）。28例（10.3%）患者发生术后并发症，包括发热12例（4.4%）、需镇痛治疗的腰痛7例（2.6%）、石街2例（0.7%）、超过24 h血尿7例（2.6%），无感染性休克、脓毒血症等严重并发症发生。多因素logistic回归分析显示手术时间是发生并发症的危险因素（95%CI=1.030~1.222，P=0.008）。结论：针对大于2 cm的上尿路结石输尿管软镜钬激光碎石取石术是一种有效、安全的治疗方式。肾积水是影响结石清除率的独立因素，而手术时间是影响术后并发症发生的危险因素。

Abstract:

Objective：To assess the efficacy and safety of flexible ureteroscopy retrograde surgery（fURS） for the treatment of uri－nary calculi over 2 cm in diameter. Methods：The data of 272 patients who underwent fURS by standard techniques for urinary cal－culi over 2 cm was collected retrospectively. Demographic，intraoperative，and postoperative data were reviewed and compared to e－valuate the efficacy and safety and to find statistically significant differences. Results：Totally 272 patients（male 188，female 84） were enrolled including 254 cases of renal stone，18 cases of upper ureteral stone and 6 cases of renal stone combined with ureteral stone，and the median age of all patients was 46.5. The cumulative stone diameter（CSD） was （34.2±9.7） mm. Overall stone free rate within 30 days was 90.5%，and overall stone free rate within 90 days was 93.8%. The incidence of complications was 10.3%，including fever in 12 cases（4.4%），steinstrasse in 2 cases（0.7%），hematuria over 24 hours in 7 cases（2.6%） and backache in 7 cases（2.6%）. Logistic regression indicated that hydronephrosis was an independent factor affecting stone clearance（95%CI=5.31 to 7 133.90，P=0.004），and the operation time was the factor affecting the complication rate（95%CI=1.030 to 1.222，P=0.008）. Conclusion：Flexible ureteroscopy is an effective and safe management method for over 2 cm urinary stones. Hydronephrosis may affect the stone free rate，and operation time may affect the complication rate.