零射线完全超声引导软性输尿管镜术的安全性及疗效评估

宋超; 廖文彪; 熊云鹤; 孟令超; 杨嗣星

doi:10.13201/j.issn.1001-1420.2018.07.005

零射线完全超声引导软性输尿管镜术的安全性及疗效评估

- 武汉大学人民医院泌尿外科(武汉, 430060)

详细信息

通讯作者: 杨嗣星,E-mail:sxyang2004@163.com

中图分类号: R699

收稿日期: 2018-05-21

Solely ultrasonic guided standardized retrograde flexible ureteroscopy for renal stones:evaluation of safety and efficacy

- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, China

More Information

Corresponding author: YANG Sixing, E-mail: sxyang2004@163.com

Received Date: 21 May 2018

摘要

摘要: 目的:探讨零射线完全超声引导下行软性输尿管镜术治疗肾结石、肾盏憩室结石的安全性及有效性。方法:回顾性分析2016年1月~2017年12月在我中心接受零射线完全超声引导下软性输尿管镜术治疗的330例肾结石及肾盏憩室结石患者的临床资料。其中肾盂及肾盏结石患者312例(肾盂及肾盏结石组),肾盏憩室结石患者18例(肾盏憩室结石组)。312例患者中261例结石位于上盏、中盏或肾盂内,51例位于下盏;单发结石275例,37例位于多个肾盏,均为单侧病变。平均结石大小(1.47±0.24) cm,平均年龄(47.65±21.32)岁,平均体重指数(21.8±5.33) kg/m²。18例肾盏憩室结石患者均有临床症状,均为单侧肾盏憩室结石;结石位于肾上极13例、中部4例、下极1例;平均结石大小(1.35±0.92) cm,平均年龄(31.44±18.26)岁,平均体重指数(22.4±6.53) kg/m²。零射线完全超声引导下软性输尿管镜碎石术通过直视及B超引导实现安全的软镜术操作。收集并分析本组患者手术时间、结石清除率及围手术期并发症等资料。结果:肾盂及肾盏结石组患者平均手术时间为(58.3±26.8) min,术后4周一期清石率92.6%(289/312),术后平均住院(4.8±2.1) d,术后ClavienⅠ级并发症13例,表现为发热2例、疼痛3例、恶心或呕吐1例、持续性血尿7例。肾盏憩室结石组患者平均手术时间(75.6±33.8) min,全部成功寻获结石并成功碎石(100%),术后4周一期清石率83.3%(15/18),术后平均住院(5.3±1.6) d,术后ClavienⅠ级并发症1例,为体温<38.5℃的发热;ClavienⅡ级并发症1例,为肾绞痛,给予对症治疗后症状消失。两组输尿管损伤发生率分别为15.1%(47/312)和27.8%(5/18),损伤绝大多数为输尿管黏膜损伤分别为93.6%(44/47)和100%(5/5),2例为浅肌层损伤,1例为输尿管穿孔。两组患者均未出现ClavienⅣ级或以上并发症。结论:零射线完全超声引导下软性输尿管镜术可以有效替代传统的X线引导模式,实现对适应证范围内的肾结石、肾盏憩室结石的安全高效处理。
- 超声引导 /
- 软性输尿管镜术 /
- 零射线 /
- 标准化
Abstract: Method:To evaluate the safety and efficacy of a radiation-free standardized retrograde flexible ureteroscopy (RFS-FU) using ultrasound guidance to manage renal stones in retrograde intra-renal surgery.Method:The records of 330 patients by RFS-FU with holmium laser lithotripsy in managing renal stones from January 2016 to December 2017 were retrospectively reviewed.Out of 312 cases with calculus in their collecting system, the mean stone diameter was (1.47±0.24) cm, the mean age was (47.65±21.32) years old, BMI was (21.8±5.33) kg/m².There were 261 cases with their stones in upper, middle calyx or renal pelvic, while 51 cases in lower pole.Cases with single stone or multiple stones were 275 and 37 cases, which were all unilateral cases.The 18 cases with symptomatic caliceal diverticular calculi included 13 upper pole, 4 middle kidney and 1 lower pole cases, which were all unilateral cases.Their mean stone diameter was (1.35±0.92) cm, the mean age was (31.44±18.26) years old, BMI was (22.4±6.53) kg/m².The RFS-FU included 7 major steps, which was trying to achieve a safe and effective surgery comparable to X-ray guided flexible ureteroscopy.Result:RFS-FUs were successfully preformed in all patients.Out of the 312 patients with collecting system stones, the mean operation time were (58.3±26.8) min, with the stone free rate of 92.6% (289/312) 4 weeks after operation.Eighteen cases with residual stones were treated with ESWL and got stone free.The postoperative hospital stay was (4.8±2.1) days.There were 13 cases experiencing complications of Clavien grade Ⅰ including 2 cases with fever, 3 cases with pain, 1 case with nausea or vomiting and 7 cases with persistent hematuria.Out of 18 cases with symptomatic caliceal diverticular calculi, the mean operation time was (75.6±33.8) min, all stones were localized and fragmented successfully.The stone free rate after 4 weeks was 83.3% (15/18).The average hospital stay was (5.3±1.6) days.One patient experienced fever (Clavien Ⅰ) and 1 patient experienced renal colic (Clavien Ⅱ).Those symptoms were relieved after the conservative treatment.Ureteral wall injury was seen in 15.1% (47/312) and 27.8% (5/18) cases in 2 groups, majority of which were mucosal injury (93.6%, 44/47 and 100%, 5/5).Two cases of superficial muscle layer injury and 1 case of ureteral perforation were recorded.No complications up to Clavien Ⅳ happened in both groups according to modified Clavien grading system.Conclusion:The radiation-free standardized retrograde flexible ureteroscopy using ultrasound guidance can replace X-ray guidance and be carried out in the renal stone cases with indication in an effective and safe fashion without ionizing radiation.
- ultrasonic guidance /
- flexible ureteroscopy /
- radiation free /
- standardized

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