摘要目的 评估输尿管软镜联合钬激光治疗分支型肾盂鹿角形结石疗效及安全性。方法 回顾性分析2013年11月~2016年2月采用输尿管软镜联合钬激光治疗分支型肾盂鹿角形结石47例(53侧),以23例(25侧)经皮肾镜治疗的同类型结石病例作为对照,对结石清除率,术中、术后并发症等进行统计,Logistic回归分析影响结石清除率的风险因素。结果 与经皮肾镜相比,软镜联合钬激光具有较高的Ⅰ期结石清除率(79.2% vs. 44.0%),手术时间偏长(125.45±30.01)min vs. (105.44±32.5)min,术后平均住院日明显缩短(4.55±1.15)d vs. (7.56±1.66)d,损伤和出血相对较少,无严重并发症发生。回归分析提示肾盂下盏漏斗夹角<30°及肾下盏长度是影响其结石清除率的独立风险因素。结论 输尿管软镜联合钬激光治疗分支型肾盂鹿角形肾结石安全有效,术前评估需重点测量肾盂下盏漏斗夹角及肾下盏长度。
Abstract：Objective: To evaluate the efficacy and safety of flexible ureteroscopic holmium laser lithotripsy in the treatment of staghorn calculi in branch shaped renal pelvis. Methods: Forty-seven cases, 53 laterals with staghorn calculi in branch shaped renal pelvis subject to retrograde intrarenal surgery (RIRS) with flexible ureteroscope and holmium laser in our hospital from November 2013 to February 2016 were analyzed retrospectively. Twenty-three cases, 25 laterals with the same calculi treated with percutaneous nephrolithotomy served as controls. The stone free rate, intraoperative and postoperative complications were recorded, and the factors influencing the stone free rate were analyzed by Logistic regression. Results: As compared with percutaneous nephrolithotomy, flexible ureteroscopic holmium laser lithotripsy had higher stone free rate (79.2% vs. 44.0%), longer operation time [(125.45±30.01) vs. (105.44±32.5) min], shorter hospital stay [(4.55±1.15) vs. (7.56±1.66) days], less injury and blood loss. No serious complications occurred. Logistic regression analysis showed that the infundibular length of lower calyces and infundibulopelvic angle less than 30 degree were the independent risk factors of the outcome of RIRS. Conclusions: Ureteroscopic holmium laser lithotripsy is a safe and effective therapy in the treatment of this special type of renal calculi. The infundibular length of lower calyces and infundibulopelvic angle should be focused on preoperatively.
[1] Preminger GM, Assimos DG, Lingeman JE, et al.Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol, 2005,173(6):1991-2000. [2] Al-Qahtani SM, Gil-Deiz-de-Medina S, Traxer O. Predictors of clinical outcomes of flexible ureterorenoscopy with holmium laser for renal stone greater than 2 cm. Adv Urol, 2012:543537. [3] Astroza G, Lipkin M, Neisius A, et al.Effect of supine vs prone position on outcomes of percutaneous nephrolithotomy in staghorn calculi: results from the clinical research office of the endourology society study. Urology, 2013,82(6):1240-1244. [4] Sampaio FJ.Renal collecting system anatomy: its possible role in the effectiveness of renal stone treatment. Curr Opin Urol, 2001,11(4):359-366. [5] Gupta M, Lee MW.Treatment of stones associated with complex or anomalous renal anatomy. Urol Clin North Am, 2007,34(3):431-441. [6] Knoll T, Buchholz N, Wendt-Nordahl G.Extracorporeal shockwave lithotripsy vs. percutaneous nephrolithotomy vs. flexible ureterorenoscopy for lower-pole stones. Arab J Urol, 2012,10(3):336-341. [7] Resorlu B, Oguz U, Resorlu EB, et al.The impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery in patients with lower pole renal stones. Urology, 2012,79(1):61-66. [8] Jessen JP, Honeck P, Knoll TA.Flexible ureterorenoscopy for lower pole stones: influence of the collecting system's anatomy. J Endourol, 2014,28(2):146-151. [9] Ullah A, Zubair M, Khan N, et al.Frequency and factors effecting non clearance of lower pole renal stones. J Ayub Med Coll Abbottabad, 2015,27(2):384-387. [10] Kourambas J, Byrne RR, Preminger GM.Does a ureteral access sheath facilitate ureteroscopy?. J Urol, 2001,165(3):789-793. [11] Traxer O, Thomas A.Prospective evaluation and classification of ureteral wall injuries resulting from the insertion of a ureteral access sheath during retrograde intra-renal surgery (RIRS). J Urol, 2013,189(2):580-584. [12] 朱世斌,李恭会,张志根.预留置输尿管支架管在输尿管软镜手术中的应用.2014年微创外科学术年会论文汇编.中国浙江杭州: 浙江省科学技术协会,2014:234. [13] Mahajan PM, Padhye AS, Bhave AA, et al.Is stenting required before retrograde intrarenal surgery with access sheath. Indian J Urol, 2009,25(3):326-328. [14] Doizi S, Knoll T, Scoffone CM, et al.First clinical evaluation of a new innovative ureteral access sheath (Re-TraceTM): a European study. World J Urol, 2014,32(1):143-147. [15] Ullah A, Zubair M, Khan N, et al.Is routine ureteral stenting really necessary after retrograde intrarenal surgery?. Arch Ital Urol Androl, 2015,87(1):72-75.
