摘要
目的探讨4种结石封堵器在输尿管硬镜下治疗输尿管上段结石中原位碎石的疗效。方法回顾性分析2017年7月至2018年3月经输尿管硬镜钬激光碎石术中联合应用4种不同封堵器治疗131例输尿管上段结石患者的临床资料,其中使用CookN-trap38例、CookN-gage取石网篮15例、瑞邦国产StoneCone42例和英诺伟管路封堵器(IVX-SC10)36例。所有患者结石均位于第4腰椎横突以上,合并有不同程度肾积水。统计四组患者手术时间、结石清除率、术后并发症等数据并进行分析。结果手术时间:CookN-trap(10.0~16.5)min、CookN-gage取石网篮(8.0~12.5)min、瑞邦国产StoneCone(15.5~30.5)min和英诺伟封堵器(12.5~30.0)min。5例结石退入肾盂肾盏,其中3例停留于肾盂,继续输尿管镜上行至肾盂予钬激光成功碎石,术后复查未见结石残留,2例结石入肾盏术后予体外冲击波碎石并排石成功,一次性结石取净率为96.1%(126/131)。术中均未出现输尿管穿孔或输尿管黏膜撕脱。术后3例患者出现发热,经抗生素治疗后好转。结论输尿管硬镜联合封堵器及钬激光碎石原位处理输尿管上段结石疗效确切,安全可行,结石清除率高,术后并发症少,显著减少因结石逃逸改行输尿软镜及经皮肾镜手术。
Objective To investigate the effect of 4 kinds of stone occluder in the treatment of upper ureteral calculi with middle primary lithotripsy under rigid ureteroscope. Methods The data of 131 patients with upper ureteral calculi treated with 4 different occluder devices during ureteroscopic holmium: YAG laser lithotripsy from July 2017 to March 2018 were retrospectively analyzed. Among them, 38 cases were treated with Cook N-trap and 15 cases were treated with Cook N-trap. Forty-two cases of Stone Cone and 36 cases of IVX-SC10 were performed. All the patients had stones above the 4th lumbar vertebra transverse process and complicated with different degrees of hydronephrosis. The specific method was to use Wolf 67.5 single channel ureteroscope, zebra guide wire guide to see stones, slowly cross stones in the lower space of stones, and operate the handle of occluder to block stones and fix stones, holmium laser in situ lithotripsy with the same working channel.The operation time, stone clearance rate and postoperative complications were analyzed. Results The operation time was: N-trap(10.0-16.5)min, N-gage (8.0-12.5)min, Stone Cone(15.5-30.0)min and IVX-SC10(12.5-30.0)min. Five cases of calculi entered renal pelvis and calyx, of which 3 cases remained in renal pelvis, and continued ureteroscope to renal pelvis with holmium laser lithotripsy. After operation, 2 cases without residual stones were treated with extracorporeal shock wave lithotripsy (ESWL) and successful lithotripsy. The stone removal rate was 96.1%.There was no ureteral perforation or ureteral mucosal avulsion during operation, and fever occurred in 3 patients after operation and was improved after antibiotic treatment. Conclusions The ureteroscopy combined with occluder and holmium laser lithotripsy for the treatment of upper ureteral calculi is effective, safe and feasible, with high stone clearance rate, less postoperative complications, and significant reduction of flexible ureteroscope and percutaneous nephroscope surgery.
作者
尹冰德
巫嘉文
Yin Bingde;Wu Jiawen(Department of Urology, Minhang Branch, Zhongshan Hospital Affilated to Fudan University, Shanghai 201199, China)
出处
《国际泌尿系统杂志》
2019年第3期412-415,共4页
International Journal of Urology and Nephrology
