输尿管软镜治疗肾结石的安全性和有效性分析（附716例报道）

Analysis on the safety and effectiveness of flexible ureteroscopy in the treatment of renal calculi（716 cases）

摘要:

目的：探讨输尿管软镜联合钬激光碎石治疗肾结石的安全性和有效性。方法：回顾性分析2017年7月至2017年12月我科收治的716例肾结石患者，行输尿管软镜钬激光碎石手术，其中一期手术组377例，术前留置双J管二期手术组339例，统计软镜工作鞘置入成功率、手术时间、住院时间、结石清除率、并发症发生率等；并发症包括输尿管损伤、狭窄、发热及尿源性脓毒症、大出血等。结果：2组术前结石大小、结石位置、结石清除率（94.1% vs. 93.7%）等无统计学差异（P >0.05），但一期手术组与二期手术组在工作鞘置入成功率（90.2% vs. 100%）上有明显统计学差异（P<0.05）。2组均未出现输尿管撕脱、尿源性脓毒症等严重并发症。结论：术前免留置双J 管行一期输尿管软镜钬激光碎石安全有效，与二期输尿管软镜手术相比，无明显差异，一期手术成功率关键取决于软镜工作鞘置入成功与否，与患者本身输尿管是否狭窄、扭曲等，以及术者经验有关。

Abstract:

Objective：To analyze the efficacy and safety of flexible ureteroscopy with holmium laser（FURS） without a pre-existing ureteral stent for renal calculi. Methods：Clinical data of 716 patients who underwent FURS from July 2017 to December 2017 at this hospital were analyzed retrospectively. There were 377 patients without pre-existing ureteral stent and 339 patients with pre-existing ureteral stent. The overall the success rate of ureteral access sheath placement，operation time，overall hospital stay，stone free rate （SFR） and overall complication rate were compared between the two groups. Results：There was no significant difference between two groups in the preoperative stone size，stone location and SFR（94.1% vs. 93.7%）（P>0.05）. But there were significant differences be－tween two groups in the success rate of ureteral access sheath placement（90.2% vs.100.0%）（P<0.05）. No serious complication occurred in two groups. Conclusion：It is safe and effective for the FURS without pre-existing ureteral stent. Compared with the pre-existing group，there was no significant difference in the results. The success rate of FURS without pre-existing ureteral stent depends on the success of the sheath implantation and is related to the stricture or distortion of ureter，as well as the surgeon’s experience.