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逆行软性输尿管镜下钬激光碎石术治疗肾结石的有效性与安全性分析

Efficacy and safety of retrograde flexible ureteroscopic lithotripsy with holmium:YAG laser in the treatment of renal stones

摘要:

目的:评价逆行软性输尿管镜下钬激光碎石术治疗肾结石的临床疗效及安全性。方法回顾性收集2013年1—12月采用逆行软性输尿管镜下钬激光碎石术治疗466例肾结石患者的资料。结石最大径为(23±16) mm。评估结石清除率( stone free rate,SFR)、术后并发症发生率和重复治疗率。结果466例手术时间(33.5±18.8) min,住院天数(2.3±2.0) d。一次软性输尿管镜术后SFR为67.6%(315/466)。20例(4.3%)接受了≥2次治疗,466例共行逆行软性输尿管镜下钬激光碎石术493次,平均1.06次/人。术后3个月总SFR为69.5%(324/466)。总并发症发生率为14.4%(67/466),其中输尿管假道形成5例,输尿管穿孔3例,石街形成9例,肾周血肿1例,术后发热50例(10.7%),其中尿脓毒血症16例(3.4%)。当结石最大径≤10、11~20、21~30、31~40、>40 mm时,一次软性输尿管镜术后 SFR 分别为97.0%(65/67)、84.2%(160/190)、63.1%(70/111)、29.2%(14/48)、12.0%(6/50)(P <0.001),术后发热率分别为1.5%(1/67)、9.5%(18/190)、13.5%(15/111)、14.6%(7/48)、18.0%(9/50)(P=0.030),差异均有统计学意义。术前尿白细胞阳性和阴性患者的术后发热率分别为19.3%(27/140)和7.1%(23/326)(P<0.001),术前尿培养阳性和阴性患者的术后发热率分别为22.0%(22/100)和7.7%(28/366)(P<0.001),差异均有统计学意义。结论逆行软性输尿管镜下钬激光碎石术治疗肾结石安全、有效,但随着结石直径增大,SFR降低,术后发热率增高。

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Objective To evaluate the efficacy and safety of retrograde flexible ureteroscopic lithotripsy ( RFUL) with holmium:YAG laser for the treatment of renal stones with a large series.Methods The data of 466 patients who underwent RFUL with holmium:YAG laser for the treatment of kidney stones between January 2013 and December 2013 were collected.The maximum diameter of stone was 23 ±16 mm.The stone free rate, complications, retreatment rate were evaluated.Results Out of the 466 patients, the mean operative time and postoperative hospital stay were 33.5 ±18.8 min and 2.3 ±2.0 d.The stone free rate was 67.6% ( 315/466 ) after single procedure, which increased to 69.5% ( 324/466 ) via re-treatments after 3 months.The retreatment rate was 4.3%(20/466), with a total of 493 RFUL procedures performed and 1.06 times per patient.There were 67 (14.4%) cases undergoing complications.Five cases had false passage of ureter orifice causing slight ureteral wall injuries.Steinstrasse occurred in 9 cases, ureteral perforation in 3 cases and perirenal hematoma in 1 case.Overall postoperative fever rate was 10.7%(50/466) with urosepsis in 16 cases (3.4%).When the stone size was≤10, 11-20, 21-30, 31-40, and >40 mm, the stone free rates after a single procedure were 97.0% ( 65/67 ) , 84.2% ( 160/190 ) ,&nbsp;63.1%(70/111), 29.2%(14/48), 12.0%(6/50) (P<0.001), and the postoperative fever rates were 1.5%(1/67), 9.5%(18/190), 13.5% (15/111), 14.6% (7/48), 18.0% (9/50), respectively. The postoperative fever rates were 19.3%(27/140) and 7.1%(23/326) (P<0.001) in the patient with positive and negative preoperative urine leukocyte, and 22.0% ( 22/100 ) and 7.7% ( 28/366 ) ( P <0.001) in patients with positive and negative preoperative urine culture.Conclusions RFUL with holmium:YAG laser is a safe and effective treatment for kidney stones.The postoperative fever rate would increase and stone free rate would reduce with the increased stone size.

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