切换至 "中华医学电子期刊资源库"

中华腔镜外科杂志(电子版) ›› 2022, Vol. 15 ›› Issue (04): 222 -226. doi: 10.3877/cma.j.issn.1674-6899.2022.04.007

论著

输尿管软镜处理大于3 cm肾结石的有效性和安全性评价
崔亮1,(), 付春龙1, 代晓飞1, 张讯1, 靖万林1, 孙晓俊1, 李景敏1   
  1. 1. 100123 北京,民航总医院泌尿外科
  • 收稿日期:2022-06-08 出版日期:2022-08-30
  • 通信作者: 崔亮
  • 基金资助:
    国家自然科学基金资助项目(面上项目)(51375494)

Evaluation of the efficacy and safety of flexible ureterorenoscopy in the treatment of renal calculi larger than 3 cm

Liang Cui1,(), Chunlong Fu1, Xiaofei Dai1, Xun Zhang1, Wanlin Jing1, Xiaojun Sun1, Jingmin Li1   

  1. 1. Urology Department of Civil Aviation General Hospital, Beijing 100123, China
  • Received:2022-06-08 Published:2022-08-30
  • Corresponding author: Liang Cui
目的

探讨应用输尿管软镜(flexible ureterorenoscopy,FURS)处理直径>3 cm肾结石的有效性和安全性。

方法

回顾性分析2017年1月至2021年1月采用FURS下激光碎石取石术治疗直径>3 cm肾结石52例,其中单侧肾结石42例、双侧肾结石10例;下盏铸形结石24例、鹿角形结石5例,结石直径3.2~6.0 cm。所有患者均预留置单侧或双侧输尿管支架管至少10 d后行FURS手术。术后1 d及术后4周时行影像学(KUB)复查,评估碎石后效果。

结果

52例患者单次手术成功率100%,手术时间60~305 min,平均135.4 min;术后无发热,无严重并发症,术后1 d复查结石清除率86.5%,术后1个月复查结石清除率100%。

结论

对于熟练掌握FURS的中心,FURS单次手术治疗直径>3 cm的肾结石是一种相对安全、有效的临床方法。

Objective

To explore the feasibility and safety of flexible ureterorenoscopy(FURS) in the treatment of renal calculi larger than 3 cm and the surgical techniques in clinical practice.

Methods

52 cases of kidney stones larger than 3 cm in diameter were treated with FURS, including 42 cases of unilateral kidney calculi, 10 cases of bilateral kidney calculi, 24 cases of lower calyceal cast calculi, 5 cases of renal pelvis cast calculi with a stone diameter of 3.2-6.0 cm. FURS was performed in all patients after 10 days of unilateral or bilateral ureteral stent indwelling. KUB was performed on the first day and fourth week after operation to evaluate the effect of lithotripsy.

Results

The single operation success rate of 52 patients was 100%, the operation time was 60-305 min, and the average time was 135.4 min. there was no fever and serious complications after operation. The calculi clearance rate was 86.5% on the first day after operation, and 100% one month after operation.

Conclusions

For centers skilled in Furs, FURS is a relatively safe and effective clinical method for the treatment of kidney calculi larger than 3 cm.

图1 肾下盏铸形结石的处理技巧注:A.击打位置自结石近输尿管软镜处;B.逐渐向远处击打;C.击打过程中将已击碎结石冲出或取出;D.输尿管软镜绕过结石前端从侧方向远端击打;E、F.待铸形结石部分碎裂松动后,撤回输尿管软镜再次从近端结石处击打
1
Hudson RG, Conlin MJ, Bagley DH. Ureteric access with flexible ureteroscopes: effect of the size of the ureteroscope[J]. British Journal of Urology International, 201595(7):1043-1044.
2
Tiselius HG, Ackermann D, Alken P, et al. Eau guidelines on urolithiasis[J]. European Urology, 202040(4):362-371.
3
Assimos D, Krambeck A, Miller NL, et al. Surgical management of stones: american urological association/endourological society guideline, part I[J]. Journal of Urology, 2016:1161-1169.
4
黄健. 中国泌尿外科和男科疾病诊断治疗指南(2019版)[M].北京:科学出版社,2020.
5
中华医学会泌尿外科学分会结石学组,中国泌尿系结石联盟. 经皮肾镜取石术中国专家共识[J]. 中华泌尿外科杂志202041(6):401-404.
6
鄢羽中,周建辉,苏开德,等. 经皮肾镜取石术与输尿管软镜碎石术治疗上尿路结石疗效的Meta分析[J]. 现代泌尿外科杂志201621(8):617-622.
7
Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery[J]. J Urol, 2013189(2):580-584.
8
Deininaer S, Haberstock L, Todenhoefer T, et al. Single-use versus reusable ureteroscopes for retrograde intrarenal surgery (RIRS): systematic comparative analysis of physical and optical properties in three different devices[J]. European Urology Supplements, 201817(2):1398.
9
Proietti S, Dragos L, Molina WR,et al. Comparison of new single-use digital flexible ureteroscope versus nondisposable fiber optic and digital ureteroscope in a cadaveric model[J]. Journal of Endourology, 2016:655-659.
10
Ventimiglia E, Godínez AJ, Traxer O, et al. Cost comparison of single-use versus reusable flexible ureteroscope: a systematic review[J]. Springer Journal202046(1): 40-45.
11
Donaldson JFF. In the era of flexible ureteroscopy is there still a place for shock-wave lithotripsy: opinion: yes[J]. International braz j urol: official journal of the Brazilian Society of Urology, 201541(2):199-202.
12
曾国华,朱玮,钟文. 浅谈关于输尿管软镜术几个有争议的问题[J]. 临床泌尿外科杂志2014, 29 (12):1041-1044.
13
Kaplan AG, Neisius A, Radvak D, et al. Evaluation of a novel single-use flexible ureteroscope[J]. Journal of Urology, 201615(3):1031.
14
周志均,李响. 输尿管软镜碎石术前预置双J管必要性的荟萃分析[J]. 中华泌尿外科杂志202041(2):138-146.
15
何士尧,丁克文,吕建裕. 鞘外持续引流对输尿管软镜术后全身炎症反应综合征的预防作用[J]. 国际泌尿系统杂志202040(2):193-194.
16
李强,王文佳,宋志强,等. 输尿管软镜钬激光碎石取石术应用于>2 cm上尿路结石的临床疗效和安全性[J]. 临床外科杂志202028(2):116-119.
17
Shvero A, Herzberg H, Zilberman D, et al. Is it safe to use a ureteral access sheath in an unstented ureter[J]. Bmc Urology, 201919(1):1-4.
18
Zhong W, Leto G, Wang L, et al. Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy: a study of risk factors[J]. Journal of Endourology, 2014,25-28.
19
Ludwig WW, Lim S, Dan S, et al. Endoscopic stone measurement during ureteroscopy[J]. Journal of Endourology, 201832(1):34-39.
20
Kallidonis P, Zsoy M, Kyriazis I, et al. Histological changes caused by the prolonged placement of ureteral access sheaths: an experimental study in porcine model[J]. European Urology Supplements, 201716(7):2590.
21
Wendt-Nordahl G, Mut T, Krombach P, et al. Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors[J]. Urological Research, 201139(3): 185-188.
22
崔亮,李建民,殷小涛,等. 机器人辅助输尿管软镜手术系统的研制及试验评价[J]. 临床泌尿外科杂志201833(7):511-515.
23
李建民,张增玉,赵建厂,等. 基于视觉反馈的输尿管软镜机器人运动补偿策略[J]. 天津大学学报(自然科学与工程技术版), 202154(7):738-749.
24
Rassweiler J, Fiedler M, Charalampogiannis N, et al. Robot-assisted flexible ureteroscopy: an update[J]. Urolithiasis, 2018, 46(1):69-77.
25
刘敏,高小峰. 铥光纤激光碎石基础研究和临床应用进展[J]. 中华泌尿外科杂志202142(1):75-78.
26
Enikeev D, Grigoryan V, Fokin I, et al. Endoscopic lithotripsy with a superpulsed thulium-fiber laser for ureteral stones: a single-center experience[J]. Int J Urol, 202128(3):261-265.
[1] 万颂, 华伟, 兰红梅, 骆正馨, 万跃平. 前列腺钬激光整块剜除术与经尿道前列腺电切术治疗前列腺增生的比较[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(05): 427-431.
[2] 林枫, 陶水祥, 王钢, 徐家栋, 林奕伟, 郑祥义. 一期软性输尿管镜治疗上尿路结石的置鞘成功率及疗效分析[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(05): 432-436.
[3] 艾合买提·艾买尔, 阿不力孜·司马义, 雷鹏, 塔来提·塔依尔, 张小安, 亚力坤·阿里木, 文彬, 唐矛. 输尿管软镜下钬激光内切开治疗肾盂旁囊肿的临床分析[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(04): 339-342.
[4] 钱友良, 黄朝友, 赖飞, 杨振, 蔡勇, 李娇. 经尿道精囊镜摩西技术钬激光碎石治疗血精伴精囊结石[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(04): 347-350.
[5] 吴杰英. 输尿管软镜钬激光碎石取石术[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(03): 0-0.
[6] 黄文涛. 左侧输尿管软镜钬激光碎石术[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(03): 0-0.
[7] 林剑峰, 叶志彬, 梁福律, 范先明, 胡力仁, 涂建平, 郭昭建. 一次性输尿管软镜在具有内镜损害高危因素上尿路结石手术中的初步应用[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(03): 231-234.
[8] 吉春冬, 王健宇, 刘凯. 改良体位钬激光碎石联合套石篮对复杂性输尿管上段结石的疗效分析[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(01): 60-63.
[9] 李帛, 武国军, 李振宇, 袁建林, 郑万祥, 杨力军, 王福利, 刘飞. 经皮肾通道顺行输尿管软/硬镜联合输尿管镜治疗恶性输尿管梗阻[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(01): 64-68,80.
[10] 缪勋忠, 庞建, 胡峰, 唐观林. 同期输尿管软镜钬激光碎石术治疗双侧上尿路结石[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(01): 77-80.
[11] 汪洋, 李志鹏, 王可兵. 经尿道前列腺钬激光剜除术并发症的研究进展[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(01): 93-96.
[12] 龚宾宾, 宋正尧, 徐雨辰, 王建忠, 樊松, 梁朝朝, 郝宗耀. 6.0/7.5 F输尿管镜联合200 μm光纤在治疗输尿管中下段结石中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(06): 507-510.
[13] 杨守东, 肖东明, 司徒杰, 胡成, 张浩. 封堵器联合钬激光治疗输尿管中上段结石的临床疗效分析[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(06): 511-515.
[14] 汤庆峰, 黄晓科, 刘承万, 赖维奇, 李亮. 低功率钬激光前列腺剜除术治疗老年良性前列腺增生临床分析[J]. 中华老年病研究电子杂志, 2022, 09(03): 37-41.
[15] 闫忠孝. 经尿道钬激光膀胱肿瘤切除术与等离子膀胱肿瘤切除术治疗老年前列腺增生的疗效比较[J]. 中华老年病研究电子杂志, 2022, 09(03): 42-45.
阅读次数
全文


摘要