经皮肾镜取石术治疗重度肾积水的输尿管上段结石：不同碎石器的评估。

Percutaneous nephrolithotomy for proximal ureteral calculi with severe hydronephrosis: assessment of different lithotriptors.

机构信息

Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

J Endourol. 2010 Feb;24(2):201-5. doi: 10.1089/end.2009.0350.

DOI:10.1089/end.2009.0350

PMID:20039821

Abstract

PURPOSE

We compared the efficacy and safety of percutaneous nephrolithotomy (PCNL) with different intracorporeal lithotriptors for proximal ureteral stones in patients with severe hydronephrosis.

PATIENTS AND METHODS

We retrospectively analyzed the records of 192 patients with proximal ureteral calculi and severe hydronephrosis who underwent PCNL between February 2003 and December 2007. Calculi were fragmented with a pneumatic lithotriptor in 44 patients (group 1), Swiss Lithoclast Master in 54 (group 2), low-power holmium:yttrium-aluminum-garnet (YAG) laser in 56 (group 3) and high-power holmium:YAG laser in 38 (group 4). Patients were assessed about 12 months postoperatively with intravenous urography and ultrasonography for late complications. Stone size, operative time, stone-free rate, and follow-up were analyzed in each group.

RESULTS

Mean stone size for different groups were 16.2 +/- 2.8 mm, 16.6 +/- 2.1 mm, 16.0 +/- 2.7 mm, and 16.4 +/- 1.1 mm, respectively. Average operative time for different groups were 118 +/- 17 minutes, 81 +/- 10 minutes, 85 +/- 14 minutes, 110 +/- 16 minutes, respectively. Group 2 and group 3 showed superior outcomes of shorter operative time (P = 0.000). The overall stone-free rate was 86.5%. As stratified by lithotriptors, the stone-free rate was 81.8% in group 1, 92.9% in group 2, 88.9% in group 3, and 78.9% in group 4 (P = 0.190). No significant difference was found among the groups in terms of blood loss and postoperative hospital stay. Repeated PCNL or shockwave lithotripsy was necessary as an auxiliary procedure in 26 patients. The overall complication rate was 18.2%; most complications were minor and insignificant. During the follow-up, ureteral stricture developed in 10 patients and new renal stones developed in 4 patients.

CONCLUSIONS

PCNL combined with Swiss Lithoclast Master or low-power holmium:YAG laser is the preferred endourologic modality for the management of proximal ureteral calculi in patients with severe hydronephrosis.

摘要

目的

我们比较了不同的腔内碎石器行经皮肾镜取石术（PCNL）治疗合并重度肾积水的输尿管上段结石的疗效和安全性。

患者和方法

回顾性分析 2003 年 2 月至 2007 年 12 月期间 192 例合并重度肾积水的输尿管上段结石患者行经皮肾镜取石术的临床资料。44 例患者（A 组）使用气压弹道碎石器碎石，54 例（B 组）使用瑞士 Lithoclast Master 碎石器，56 例（C 组）使用低功率钬激光碎石，38 例（D 组）使用高功率钬激光碎石。术后 12 个月行静脉肾盂造影和超声检查评估有无晚期并发症。对各组的结石大小、手术时间、结石清除率和随访情况进行分析。

结果

各组的结石平均大小分别为 16.2±2.8mm、16.6±2.1mm、16.0±2.7mm 和 16.4±1.1mm，平均手术时间分别为 118±17min、81±10min、85±14min 和 110±16min，B 组和 C 组手术时间明显短于 A 组和 D 组（P=0.000）。总体结石清除率为 86.5%。按碎石器分层，A 组结石清除率为 81.8%，B 组为 92.9%，C 组为 88.9%，D 组为 78.9%（P=0.190）。各组的出血量和术后住院时间差异无统计学意义。26 例患者需要辅助重复 PCNL 或体外冲击波碎石。总的并发症发生率为 18.2%，多为轻微和不显著的并发症。随访期间，10 例患者发生输尿管狭窄，4 例患者发生新发肾结石。