Abstract：Objective： To evaluate the efficiency and safety of negative pressure rigid ureteroscopy combined with flexible ureteroscopy in the treatment of kidney pelvis stone with major diameter greater than 2 cm. Methods： From October 2016 to October 2019, 77 patients with kidney pelvis stone which major diameter greater than 2 cm underwent surgery, 45 patients underwent flexible ureteroscopy, and 32 patients underwent negative pressure rigid ureteroscopy combined flexible ureteroscopy at Shenzhen Traditional Chinese Medicine Hospital. The operation time, stone-free rate, hospitalization days after operation and complications were analyzed between the two groups. Results： In 32 patients given negative pressure rigid ureteroscopy combined with flexible ureteroscopy, the average operation time was （129.5 ± 8.4） min, the hospital stay was （3.1 ± 0.8） days, and the incidence of steinstrasse was 6.2% （2/32）. One patient had the temperature over 38.5°C, 2 patients were given second operation （2/32） and there was no patient with severe sepsis. In 45 patients receiving flexible ureteroscopy, the average operation time was （133.1 ± 4.5） min, the hospital stay was （3.3 ± 0.5） days, and the incidence of steinstrasse was 24.4% （11/45）. Eight patients had the temperature over 38.5°C, 12 patients were given second operation （12/45）, and there was no patient with severe sepsis. The combined group had shorter operation time, less complications and higher stones-free rate than the flexible ureteroscopy group. Conclusion： Negative pressure rigid ureteroscopy combined with flexible ureteroscopy is a safe and effective treatment for kidney pelvis stones with major diameter greater than 2 cm.
[1] 那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南(2014版).北京:人民卫生出版社,2013:129-137. [2] TÜRK C, PETŘÍK A, SARICA K, et al. EAU guidelines on interventional treatment for urolithiasis. Eur Urol, 2016,69(3):475-482. [3] HYAMS ES, MUNVER R, BIRD VG, et al.Flexible ureterorenoscopy and Holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. J Endourol, 2010,24(10):1583-1588. [4] TAKAZAWA R, KITAYAMA S, TSUJII T.Successful outcome of flexible ureteroscopy with Holmium laser lithotripsy for renal stones 2 cm or greater. Int J Urol, 2012,19(3):264-267. [5] AKMAN T, BINBAY M, OZGOR F, et al.Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis. BJU Int, 2012,109(9):1384-1389. [6] 曾国华,李佳胜,赵志健,等.逆行软性输尿管镜下钬激光碎石术治疗肾结石的有效性与安全性分析.中华泌尿外科杂志,2015,36(6):401-404. [7] 桂定文,杨嗣星,张青汉.输尿管软镜治疗肾结石的现状和展望.临床泌尿外科杂志,2014,29(5):452-457. [8] 高小峰,李凌,彭泳涵,等.输尿管软镜联合钬激光治疗2~4cm肾结石疗效分析.微创泌尿外科杂志,2013,2(1):47-49. [9] 黄晨,盛明,徐煜宇,等.输尿管软镜下钬激光治疗2~4cm肾结石的新进展.现代泌尿外科杂志,2017,22(11):882-885. [10] 钟文,赖贺,赵志健,等.输尿管软镜钬激光碎石术后全身炎症反应综合征的风险因素评估.临床泌尿外科杂志,2016,31(3):243-246. [11] 朱池海,廖邦华,朱育春,等.输尿管软镜钬激光碎石术后石街的发生率及其危险因素分析.现代泌尿外科杂志,2015,20(8):561-565,576. [12] 唐炎权,周均洪.经输尿管硬通道下硬镜钬激光碎石术治疗大体积输尿管上段结石.广东医学,2015,36(7):1048-1050. [13] 甘澍,邹乾明,傅永盛,等.负压组合输尿管镜治疗最大径>20 mm肾结石的有效性与安全性.广东医学,2016,37(15):2268-2269. [14] 甘澍,周均洪,廖芝健,等.负压组合镜治疗肾结石的临床观察.临床外科杂志,2017,25(2):104-106. [15] 唐炎权,周均洪,尹伟强,等.一期经输尿管硬通道硬镜钬激光碎石治疗输尿管上段结石梗阻性脓肾.现代泌尿外科杂志,2018,23(11):852-854,865.
