Amón J H, Cepeda M, Conde C, Alonso D, González V, Martínez-Sagarra J M
Servicio de Urología, Hospital Río Hortega, Valladolid, España.
Actas Urol Esp. 2011 Feb;35(2):108-14. doi: 10.1016/j.acuro.2010.12.004. Epub 2011 Feb 2.
Washing the renal cavities using minipercutaneous surgery shaft is an ideal technical procedure for retrograde intrarenal surgery (RIRS) when lithiasic fragmentation is significant or if the anatomy of the renal cavities may obstruct the spontaneous elimination of fragments.
we performed 37 RIRS on 35 patients with renal lithiasis (14 men, 21 women) with a mean age of 56 (range 33-72) years, divided into two groups in accordance with the size of their kidney stones. Group A, 23 patients with lithiasis <1.5 cm; Group B, 12 cases with lithiasis >1.5 cm. 28 patients had a single kidney stone and 7 had multiple stones.
Flexible uretrorenoscopy, 7.5 Fr (Flex-X(®, Karl Storz) by means of a ureteral access sheath. Holmium laser lithotripsy (Calculase®, Karl Storz) using 200 and 365 micrometer fibres. Fragment extraction with 1.7 Fr nitinol baskets (N-gage, Cook). In cases of significant fragmented stone burden, the renal cavities were washed with low-pressure fluid irrigation using a ureteral access sheath, which was collected together with the stone fragments carried by the "mini-perc" sheath (Ultrax-x® 18Fr, Cook; Rusch, 14 Fr) placed under radiologic and endoscopic control at the level of the calyx-papilla selected for fragment drainage.
the mean diameter for group A was 9.13 (range 5-13) mm and 20.25 (range 16-28) mm for group B. The overall mean operating time was 81 (range 30-160) min. Group A required 66.43±35.18 min. and group B 107.5±46.73 min. (p=0.006). The rate of absence of stones immediately after surgery was 83.2%, 93.1% at 3 months (95.6% for A and 83.3% for B; p=0.217). In no case was ureteral stenosis observed as a result of the use of ureteral access sheaths. In 7 group B patients (58.3%) with acute lithiasis and/or alteration in their pyelocaliceal anatomy, we performed active lavage of the renal cavities applying the aforementioned percutaneous technique. The mean post-surgery hospital stay was 2.1 (range 1-4) days. There were post-surgery complications (Clavien 1) in 7 patients (20%). Two patients required a second FURS.
RIRS can be effective treatment for renal lithiasis >1.5 cm. Lavage of the renal cavities helps to eliminate stone fragments, reducing the possibility of retreatment.
当结石粉碎程度较大或肾盂解剖结构可能阻碍结石碎片自然排出时，使用微型经皮肾镜手术通道冲洗肾盂是逆行性肾内手术（RIRS）的理想技术操作。
我们对35例肾结石患者（14例男性，21例女性）进行了37例RIRS手术，患者平均年龄56岁（范围33 - 72岁），根据肾结石大小分为两组。A组，23例结石<1.5 cm的患者；B组，12例结石>1.5 cm的患者。28例患者为单发性肾结石，7例为多发性肾结石。
采用7.5 Fr的可弯曲输尿管肾镜（Flex-X(®)，卡尔史托斯）经输尿管通路鞘置入。使用200和365微米光纤的钬激光碎石术（Calculase(®)，卡尔史托斯）。用1.7 Fr的镍钛合金网篮（N-gage，库克）取出碎片。在结石碎片负荷较大时, 使用输尿管通路鞘进行低压液体冲洗肾盂，冲洗液与由置于放射影像和内镜控制下的用于碎片引流的选定肾盏乳头水平的“微型经皮肾镜”鞘（Ultrax-x(®) 18Fr，库克；Rusch，14 Fr）带出的结石碎片一起收集。
A组结石平均直径为9.13（范围5 - 13）mm，B组为20.25（范围16 - 28）mm。总体平均手术时间为81（范围30 - 160）分钟。A组需要66.43±35.18分钟，B组需要107.5±46.73分钟（p = 0.006）。术后即刻无结石率为83.2%，3个月时为93.1%（A组为95.6%，B组为83.3%；p = 0.217）。未观察到因使用输尿管通路鞘导致输尿管狭窄的情况。在7例B组急性结石和/或肾盂肾盏解剖结构改变的患者（58.3%）中，我们采用上述经皮技术对肾盂进行了主动冲洗。术后平均住院时间为2.1（范围1 - 4）天。7例患者（20%）出现术后并发症（Clavien 1级）。2例患者需要再次进行FURS。
RIRS对于>1.5 cm的肾结石可能是有效的治疗方法。肾盂冲洗有助于清除结石碎片，降低再次治疗的可能性。
