输尿管软镜治疗上尿路结石十年经验总结：单中心10 413例临床分析*

Ten years experience in treatment of upper urinary calculi with RIRS: clinical analysis of 10 413 cases in single center*

摘要:

摘要：目的??对应用输尿管软镜（RIRS）治疗上尿路结石的经验进行总结，以评价该技术的安全性及临床疗效。方法 选取2007年6月－2017年6月该院采用RIRS治疗的上尿路结石患者10?413例。回顾性分析可拆卸输尿管软镜（n?=?774）、纤维输尿管软镜（n?=?2?293）和电子输尿管软镜（n?=?7?346）3种软镜治疗上尿路结石的成功率、结石清除率、手术时间、住院时间和手术并发症等差异。结果 可拆卸输尿管软镜、纤维输尿管软镜和电子输尿管软镜一期手术成功率分别为73.00%、82.99%和91.00%。二期手术（一期放置输尿管内支架管）分别为27.00%、17.01%和9.00%。结石清除率分别为87.00%、89.00%和93.00%。平均手术时间分别为（112.0±32.5）、（90.0±24.0）和（75.5±20.5）min。平均住院时间分别为（9.0±1.5）、（7.0±1.0）和（5.0±1.5）d。手术并发症发生率分别为3.62%、1.30%和0.99%。结论 采用RIRS技术治疗上尿路结石安全、有效。随着RIRS技术的不断提高，以及输尿管软镜相关设备的不断优化，提高了该项技术的手术成功率及结石清除率、降低了并发症发生率和缩短了住院天数，RIRS治疗的临床适应证将逐步扩大。

Abstract:

Abstract: Objective?To summarize the experience of retrograde intrarenal surgery (RIRS) technology in treatment of upper urinary calculi for ten years, and evaluate its safety and clinical efficacy.?Methods?From June 2007 to June 2017, we used RIRS to treat 10,413 patients with upper urinary calculi. 774 cases were treated by removable flexible ureteroscopy, 2293 cases by double-channel flexible ureteroscopy, and 7346 cases by electronic flexible ureteroscopy. Success rate, stone clearance rate, operation time, surgical complications, and length of hospital stay were analyzed respectively.?Results?The success rate of the first-stage operation of the three surgical methods was 73.00%, 82.99%, and 91.00%, respectively. The second-stage operation (first stage placement of the D-J stent) was 27.00%, 17.01% and 9.00% . respectively. The average stone free rate was 87.00%, 89.00% and 93.00%, respectively. The average operation time was (112.0?±?32.5), (90.0?±?24.0) and (75.5?±?20.5) min, respectively. The average hospitalization time was (9.0?±?1.5), (7.0?±?1.0) and (5.0?±?1.5) days, respectively. The surgical complication rate was 3.62%, 1.30% and 1.00%, respectively.?Conclusion?RIRS technology is safe, effective and reliable treatment for the upper urinary calculi. The continuous improvement and innovation of relative technology, as well as the continuous optimization of ureteroscope-related equipment, have improved the surgical success rate and stone removal rate. The data of complications and hospitalization days have been continuously reduced. It is foreseeable that the clinical indications for this technology will gradually expand.