| 摘要: |
| 目的探讨采用F8组合式输尿管软镜处理<2 cm上尿路结石的临床价值。方法2010年11月至2012年8月收住上海交通大学医学院附属新华医院的上尿路结石患者117例,男性71例、女性46例,年龄20岁~86岁,平均(49.7±13.9)岁,单发结石96例,多发结石21例。结石平均直径(1.19±0.34) cm。左侧结石61例,右侧56例。其中有22例患者事先行输尿管镜下留置D-J管2~8周(输尿管狭窄13例,尿路感染7例,肾功能不全2例)。在全麻或脊麻下,患者取截石位,先置入F8/9.8输尿管硬镜进入输尿管内行直视下扩张。输尿管上段结石尽量用硬镜在输尿管内原位碎石。退出输尿管硬镜,沿导丝置入F12/14软镜输送鞘,随后置入F8 “铂立”软镜进入肾盂内进行检查和钬激光碎石,激光功率1.0 J,频率10~20 Hz。术后常规留置F6 D-J管4周,留置导尿管1~7 d。术后第1天行腹部平片(KUB)检查碎石情况及D-J管位置,部分病例术后2~4周复查KUB,如发现残留结石直径＞6 mm的患者进一步结合体外冲击波碎石术(ESWL)治疗。结果103例病例均顺利碎石,手术时间25~85 min,平均(46±14)min,术中出血量少。术后有4例病例出现术后高热,经抗炎治疗后治愈；无明显的输尿管损伤穿孔、败血症等情况。单次结石清除率为88%(103/117)，结合ESWL后结石清除率达95.7%(112/117)。结论F8组合式输尿管软镜处理上尿路结石安全、方便，疗效可靠。 |
| 关键词: 输尿管软镜 钬激光 激光碎石术 尿路结石 |
| DOI：10.3724/SP.J.1008.2012.001377 |
| 投稿时间：2012-10-27修订日期：2012-12-12 |
| 基金项目: |
|
| Modular flexible ureteroscope and Holmium laser lithotripsy for upper urinary calculi less than 2 cm: a report of 117 cases |
| HUANG Yun-teng1△,GU Si-ping2△,JIAO Yang1,ZHANG Zun-sheng1,QI Juan1*,CHEN Jian-hua1 |
(1. Department of Urology, Xinhua Hospital, Shanghai Jiaotong University, Shanghai 200092, China
2. Micro-invasive Surgery Center, Wanxiang Micro-invasive Hospital, Quanzhou 362000, Fujian, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| ObjectiveTo evaluate the clinical value of the PolyScopeTM endoscope system (F8 modular flexible ureteroscope) in treatment of upper urinary calculi less than 2 cm in diameter. MethodsA total of 117 patients with upper urinary calculi, who were hospitalized in Xinhua Hospital from Nov. 2010 to Aug. 2012, were recruited in this study. The patients included 71 males and 46 females, aging from 20-86 (average age:49.7±13.9). Ninety-six patients had single calculi and the rest 21 had multiple calculi; 61 patients had left calculi and 56 had right calculi. The mean diameter of calculi was (1.19±0.34) cm. Twenty-two patients had been indwelled with D-J tube in advance under ureteroscope for 2-8 weeks, including 13 with ureteral stenosis, 7 with urinary tract infection and 2 with renal insufficiency. General or spinal anaesthesia were used and the patients were at cutting stone position. F8/9.8 rigid ureteroscope was inserted to the ureter for dilating the ureter, and the Holmium laser lithotripsy was performed for upper ureteral stone in situ. After dilating the ureter, the guide wire was inserted under the direct vision of F8/9.8 rigid ureteroscope, and then the F12/14 flexible ureteral access sheath was placed along the guide wire. Finally, further examination and Holmium laser lithotripsy were performed by F8 “PolyScope” modular flexible ureteroscope. The power of the laser was set at 1.0 J and the frequency was 10-20 Hz. F6 D-J tube was regularly indwelled for 4 weeks after operation and Forley urethral tube was indwelled for 1 to 7 days. KUB was performed 1 day after operation to detect the result of lithotropsy and the position of D-J tube. KUB was performed again 2-4 weeks after operation in some patients. Extracorporeal shock wave lithotripsy (ESWL) should be performed if the diameter of residual stones was larger than 6 mm. ResultsLithotripsy was successfully performed in 103 patients, with the operation time being 25-85 min (mean time: \[46±14\] min) and with less bleeding. Four patients developed high fever after operation and were cured after anti-inflammatory treatment. There was no ureteral perforation or septicaemia. The single stone-free rate of single-pass lithotripsy was 88% (103/117); when combined with ESWL, the total stone-free rate was 95.7% (112/117).ConclusionF8 modular flexible ureteroscope is safe, convenient, and effective for the lithotripsy of the upper urinary calculi. |
| Key words: flexible ureteroscope Holmium laser laser lithotripsy urinary calculi |
