Ding Jie, Huang Yunteng, Gu Siping, Chen Yifan, Peng Jie, Bai Qiang, Ye Min, Qi Jun
Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Micro-Invasive Surgery Center, Shishi Overseas Chinese Hospital, Fujian, China.
Int Braz J Urol. 2015 Jul-Aug;41(4):683-9. doi: 10.1590/S1677-5538.IBJU.2014.0086.
To evaluate the clinical efficacy of flexible ureteroscope (F-URS) combined with holmium laser lithotripter in treating renal calculi in horseshoe kidney.
From November 2010 to December 2013, the medical history and charts of sixteen patients (mean age 42.9 ± 11.6 years, range 26-66 years), including 13 males and 3 females were analyzed retrospectively. Mean stone burden was 29 ± 8 mm (range 17-42 mm2). Mean stone digitized surface area (DSA) was 321 ± 94 mm2 (range 180-538 mm2). Under spinal anesthesia in a modified lithotomy position with the head down, rigid ureteroscope was placed firstly into the ureter to reach the level of the pelvis, a zebra guide wire was inserted and following the removal of the rigid ureteroscope, an ureteral access sheath was positioned along the guide wire, then passed the URF P-5 flexible ureteroscope into the renal cavities over the guidewire. After locating the stones, holmium laser lithotripsy was performed.
The average operative time was 92 ± 16 minutes (range 74-127 min.). No major complications were encountered. Ten patients obtained stone-free status with one session, four obtained stone-free status after two sessions. Single session stone-free rate was 62.5%, overall stone-free rate was 87.5%. Two patients have small residual stones in the lower pole.
F-URS combined with holmium laser lithotripter and nitinol basket, is safe and effective in dealing with moderate stone diameter (<30 mm) in HSKs with high clearance rates and low complication rates.
评估软性输尿管镜（F-URS）联合钬激光碎石术治疗马蹄肾肾结石的临床疗效。
回顾性分析2010年11月至2013年12月期间16例患者（平均年龄42.9±11.6岁，范围26 - 66岁）的病史和病历，其中男性13例，女性3例。平均结石负荷为29±8mm（范围17 - 42mm²）。平均结石数字化表面积（DSA）为321±94mm²（范围180 - 538mm²）。在腰麻下采用头低脚高位的改良截石位，首先将硬性输尿管镜置入输尿管至肾盂水平，插入斑马导丝，移除硬性输尿管镜后，沿导丝放置输尿管鞘，然后将URF P-5软性输尿管镜经导丝送入肾腔。定位结石后，进行钬激光碎石术。
平均手术时间为92±16分钟（范围74 - 至127分钟）。未发生重大并发症。10例患者单次手术结石清除，4例患者两次手术后结石清除。单次手术结石清除率为62.5%，总体结石清除率为87.5%。2例患者下极有小的残留结石。
F-URS联合钬激光碎石术及镍钛合金网篮，在处理马蹄肾中直径<30mm的结石时安全有效，清除率高且并发症发生率低。
