术前免留置双J管一期输尿管软镜治疗肾结石的临床研究

Clinical application of flexible ureteroscopy lithotripsy in treatment of renal calculi without preexistent ureteral stent

摘要:

目的 探讨术前免留置双J管一期输尿管软镜治疗肾结石的有效性及安全性。方法 156例患者随机分成两组，观察组82例，术前免留置双J管。对照组74例，术前放置双J管。观察两组手术情况及碎石成功率及术中术后并发症。结果 两组均未出现严重血尿、脓毒血症、输尿管穿孔和输尿管撕脱等严重并发症。两组术前结石大小、结石部位差异无统计学意义（P >0.05）。观察组输尿管软镜进镜成功率93.9%（77/82），对照组100.0%，差异无统计学意义（P >0.05）。观察组软镜镜鞘置入成功率84.2%（69/82），对照组97.2%（72/74），差异有统计学意义（P <0.05）。观察组碎石成功率87.8%（72/82），对照组91.9%（68/74），差异无统计学意义（P > 0.05）。结论 术前留置双J管可增加输尿管软镜镜鞘置入成功率，但并不能明显提高碎石成功率。术前免留置双J管一期输尿管软镜治疗肾结石安全有效。

Abstract:

Objective To investigated the impact of a preexistent ureteral stent on the success rate of flexible ureteroscopy lithotripsy for renal calculi. Methods 156 patients with renal calculi were randomly divided into two groups: 82 patients were treated by flexible ureteroscopy without preexistent ureteral stent and 74 patients with preexistent ureteral stent. Preoperative patient characteristics, radiographic stone size, operation time, success rate of lithotripsy, serious complications were recorded. Result No serious complication occurred in two groups. Between two groups, there were no difference in terms of patient age, stone side, stone size, stone number (P < 0.05). Flexible ureteroscopy were successful placed in all patients in the control group, and the success rate was 93.9% in the observation group, there was no difference between two groups (P > 0.05). The success rate of ureteral access sheath placement was 84.2% in the observation group, and it was 97.2% in the control group. The success rate of lithotripsy was 87.8% in the observation group, it was 91.9% in the other group, there was no difference between two groups (P > 0.05). Conclusions It can increase the success rate of ureteral access sheath placement that indwelled ureteral stent pre-operation, but it can't increase the success rate of lithotripsy. It was safe and reliable procedure with good results, minimal surgical morbidity that lithotripsy by flexible ureteroscopy without preexistent ureteral stent.