多技巧辅助输尿管软镜治疗复杂性肾下盏结石的临床观察

Clinical observation of multi-techniques assisted flexible ureteroscopy in treatment of complex subrenal calyx calculus

摘要:

目的 探讨3种技巧［套石篮移位结石、B超定位下细针穿刺辅助移位结石和超微通道经皮肾镜取石术（SMP）］辅助输尿管软镜治疗复杂性肾下盏结石的有效性及安全性。方法 回顾性分析2017年5月－2019年6月该科采用3种技巧辅助输尿管软镜治疗102例肾下盏结石患者的临床资料。常规采用输尿管软镜无法到达的结石，使用套石篮将其转移至中上盏再碎石，套石篮难以套取的结石行B超定位下细针穿刺移位结石再碎石，以上两种方法仍难以处理者，再经细针穿刺口采用SMP。术后第1天复查腹部泌尿系X线片明确双J管情况，1个月后拔除双J管，3个月后复查CT，了解结石清除情况。通过分析术中出血量和结石清除率等指标，评估疗效。结果 102例患者中，60例使用套石篮将结石转移至肾中上盏，能成功粉碎结石，13例套石篮套不到的结石，采用B超定位下细针穿刺，能成功移位并粉碎结石，29例套石篮和细针穿刺均无法移位的结石，经细针穿刺通道行SMP成功碎石。手术时间0.5～3.0 h，平均2.1 h；术后住院时间2.0～3.0 d，平均1.5 d；术中出血0～50 mL，平均12 mL；术后3个月复查CT，结石清除率为91.2%（93/102）。无输尿管撕脱、输尿管穿孔和感染性休克等严重并发症发生。结论 3种技巧（套石篮移位结石、B超定位下细针穿刺移位结石和SMP）辅助输尿管软镜治疗复杂性肾下盏结石，是安全有效的。

Abstract:

Objective To investigate the efficacy and safety of three techniques [moving the stone with a stone basket, ultrasound-guided fine needle percutaneous renal puncture and super-mini percutaneous nephrolithotomy (SMP)] assisted flexible ureteroscopy in treatment of complex subrenal calyx calculus.Methods We retrospectively analyzed the data of 102 patients who underwent flexible ureteroscopy in the treatment of subrenal calyx calculus from May 2017 to June 2019, requiring the above-mentioned auxiliary treatment. The calculus that could not be routinely reached by flexible ureteroscope were transferred to the middle and upper calyx for lithotripsy using a stone basket. The calculus that were difficult to be removed using a stone basket were removed by ultrasound-guided fine needle percutaneous renal puncture before lithotripsy. For patients that still difficult to be treated using the above two methods, the SMP was used through the fine needle puncture port. At 1 day after the operation, abdominal plain film was repeated to check the condition of double J tubes. The double-J tube was removed 1 month later and CT was reexamined 3 months later to investigate the condition of stone clearance. The efficacy was evaluated by analyzing intraoperative blood loss and stone clearance rate.Results Among the 102 patients, 60 cases were successfully comminuted by transferring the stones to the middle and upper calyces using stone basket; 13 cases of calculus not covered with stone basket, fine needle aspiration under B ultrasound localization could successfully move and comminute the calculus; 29 cases that could not be displaced by stone basket and fine needle aspiration underwent SMP for successful lithotripsy. The surgical duration was 0.5～3.0 h, with an average of 2.1 h. Postoperative hospital stay was 2.0～3.0 d, with an average of 1.5 d. The blood loss was from 0 to 50 mL with an average of 12 mL. The stone clearance rate was 91.2% (93/102) at 3 months after surgery. There were no serious complications such as ureteral avulsion, ureteral perforation and septic shock.Conclusion Three techniques (moving the stone with a stone basket, ultrasound-guided fine needle percutaneous renal puncture and SMP) can assist flexible ureteroscopic lithotomy in treatment of complex subrenal calyx calculus, which is safe and effective.