Yan Zejun, Xie Guohai, Yuan Hesheng, Cheng Yue
Department of Urology, Ningbo First Hospital, Medical College of Ningbo University, Ningbo, Zhejiang 315010, P.R. China.
Exp Ther Med. 2015 Oct;10(4):1467-1471. doi: 10.3892/etm.2015.2703. Epub 2015 Aug 24.
To determine the safety and efficacy of modular flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal and proximal ureteral calculi, a retrospective chart review of a single surgeon's 3-year modular flexible ureteroscopy experience was performed. All of the patients were treated with modular flexible ureteroscopy and holmium laser lithotripsy by a single surgeon. Stone-free status was defined as no fragments or a single fragment ≤4 mm in diameter at the 3-month follow-up. The procedure number, operative time, stone-free rates, repeat usage of the multilumen catheter, and perioperative complications were documented. The present study included 215 male patients and 167 female patients, with an average age of 48.5±13.7 years (range, 17-84 years). The mean stone size was 11.5±4.1 mm (range, 4-28 mm), and the mean total stone burden was 17.5±5.7 mm (range 15-46 mm). A total of 305 patients (79.8%) had a stone burden ≤20 mm, and 77 patients (20.2%) had a stone burden >20 mm. The mean number of primary procedures was 1.3±0.2 (range, 1-3). The stone-free rate following the first and the second procedure was 73.4 and 86.9%, respectively. The mean postoperative hospital stay was 3.1±1.2 days (range, 2-6 days). The highest clearance rates were observed for proximal ureteral stones (100%) and renal pelvic stones (88.7%), whereas the lowest clearance rates were observed for lower calyx stones (76.7%) and multiple calyx stones (77.8%). The higher the initial stone burden, the lower the postoperative stone-free rate (≤20 vs. >20 mm; 89.8 vs. 75.3%). The overall complication rate was 8.1%. The results of the present study suggest that modular flexible ureteroscopy with holmium laser lithotripsy may be considered the primary method for the treatment of renal and proximal ureteral calculi in select patients, due to its acceptable efficacy, low morbidity, and relatively low maintenance costs.
为确定组合式软性输尿管镜及钬激光碎石术治疗肾及输尿管上段结石的安全性和有效性，我们对一位外科医生3年的组合式软性输尿管镜治疗经验进行了回顾性病历分析。所有患者均由同一位外科医生采用组合式软性输尿管镜及钬激光碎石术进行治疗。结石清除状态定义为在3个月随访时无结石碎片或仅有一个直径≤4 mm的结石碎片。记录手术例数、手术时间、结石清除率、多腔导管的重复使用情况及围手术期并发症。本研究纳入男性患者215例，女性患者167例，平均年龄48.5±13.7岁（范围17 - 84岁）。结石平均大小为11.5±4.1 mm（范围4 - 28 mm），平均总结石负荷为17.5±5.7 mm（范围15 - 46 mm）。共有305例患者（79.8%）结石负荷≤20 mm，77例患者（20.2%）结石负荷>20 mm。初次手术的平均次数为1.3±0.2（范围1 - 3）。第一次和第二次手术后的结石清除率分别为73.4%和86.9%。术后平均住院时间为3.1±1.2天（范围2 - 6天）。输尿管上段结石（100%）和肾盂结石（88.7%）的清除率最高，而下盏结石（76.7%）和多个肾盏结石（77.8%）的清除率最低。初始结石负荷越高，术后结石清除率越低（≤20 vs. >20 mm；89.8% vs. 75.3%）。总体并发症发生率为8.1%。本研究结果表明，组合式软性输尿管镜及钬激光碎石术因其疗效可接受、发病率低且维护成本相对较低，可被视为特定患者肾及输尿管上段结石治疗的主要方法。
