I期置管后Ⅱ期联合输尿管鞘下输尿管硬镜处理2~3 cm肾盂结石疗效分析

doi:10.3877/cma.j.issn.1674-3253.2021.05.014

目的

探讨输尿管硬镜钬激光碎石联合输尿管鞘治疗肾盂结石的安全性及有效性。

方法

回顾性分析2017年1月至2020年1月闵行分院收治的2~3 cm肾盂结石伴轻度肾积水的患者78例的临床资料。其中A组患者采用Ⅰ期置管，Ⅱ期行联合输尿管鞘下输尿管硬镜碎石（18例），B组患者采用Ⅰ期行输尿管硬镜碎石（22例），C组患者采用经皮肾镜钬激光碎石取石术（38例）。比较分析三种方法治疗肾盂结石的手术时间、Ⅰ期结石清除率、术后住院天数、住院费用和术后发热率和出血率。

结果

所有手术均顺利完成。手术时间A组（95±14）min，B组（106±11）min，C组（88±15）min，A组和C组差异无统计学意义（P>0.05），两者显著低于B组（P<0.05）；肾盂结石Ⅰ期结石清除率A组77.78%，B组72.73%，C组84.21%，差异无统计学意义（P>0.05）；A组患者术后低热2例中高热0例，B组患者术后低热5例中高热3例,C组患者术后低热8例，中高热3例，A组患者术后出现发热的例数低于B组和C组，但差异无统计学意义（P>0.05）；住院天数分别为A组（2.61±0.61）d，B组（3.27±0.98）d，C组（4.58±1.08）d，A组患者住院时间显著低于B组和C组，差异有统计学意义（P<0.05）。C组术后明显出血2例，经保守治疗治愈。

结论

对于2~3 cm肾盂结石，合并同侧轻度肾积水的患者，采用Ⅰ期置管，Ⅱ期行联合输尿管鞘下输尿管硬镜碎石，清石率可靠，具有创伤小、住院天数少、并发症发生率低的优势。

关键词: 预先置管, 输尿管鞘, 输尿管镜, 钬激光, 肾盂结石

Objective

To investigate the safety and efficacy of presetting double J tube and using ureteroscopic lithotripsy combined with ureteral sheath in the treatment of renal pelvis calculi.

Methods

The clinical data of 78 cases of 2-3 cm renal pelvis calculi with mild hydronephrosis from January 2017 to January 2020 were analyzed retrospectively. In group A, 18 patients were treated with presetting double J tube in phase I, ureteroscopic lithotripsy combined with ureteroscopic lithotripsy in phase II. In group B, 22 patients were treated with ureteroscopic lithotripsy.In group C, 38 patients were treated with percutaneous nephrolithotomy. The operation time, stone clearance rate, hospitalization days, hospitalization cost, postoperative fever rate and bleeding rate were compared and analyzed.

Results

All the operations were successfully completed. The operation time of group A was (95±14) min, group B (106±11) min, group C (88±15) min, there were significant differences between group B compared with group A and group C (P<0.05). The stone removal rate of stage I pyelolithiasis in group A was 77.78%, group B was 72.73%, and group C was 84.21%, the differences were not statistically significant (P>0.05). There were 2 cases of low fever and 0 case of high fever in group A, 5 cases of low fever and 3 cases of high fever in group B, 8 cases of low fever, 3 cases of moderate high fever in group C, the rate of postoperative fever in group A was lower than that in group B and group C, but the differences were not statistically significant (P>0.05). The hospitalization days in group A were (2.61±0.61) d, in group B were (3.27±0.98) d, in group C were (4.58±1.08) d, and the hospitalization days in group A were significantly lower than that in group B and group C, the differences were statistically significant (P<0.05). In group C, there were 2 cases of bleeding, which were cured by conservative treatment.

Conclusion

For the patients with 2-3 cm renal pelvis calculi and mild hydronephrosis, presetting double J tube and using ureteroscopic lithotripsy combined with ureteral sheath is reliable, with the advantages of less trauma, fewer days in hospital and low incidence of complications.

Key words: Preset double J tube, Ureteral access sheath, Ureteroscopy, Holmium laser, Renal pelvis calculi

图2 患者2多发结石患者的治疗经过

表1 三组不同结石处理方法患者一般资料的比较

组别	总数	性别(例)		年龄[岁，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	下盏解剖结构(±s)
组别	总数	男	女	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	IPA(°)	盏颈长度(mm)	盏颈宽度(mm)	盏颈宽度/盏颈长度比值
A组	18	8	10	55±15	23.0±2.9	2.51±0.29	57±23	11.6±3.7	7.2±2.5	0.63±0.07
B组	22	13	9	53±12	22.2±2.2	2.43±0.23	67±21	11.4±3.1	6.8±2.0	0.60±0.09
C组	38	25	13	50±12	22.8±2.9	2.57±0.24	55±21	13.1±2.9	7.9±2.3	0.59±0.08
统计值		χ² =2.300		F=1.194	F=0.494	F=2.055	F=2.137	F=2.466	F=1.616	F=0.601
P值		0.371		0.309	0.135	0.135	0.125	0.092	0.205	0.551

表1 三组不同结石处理方法患者一般资料的比较

组别	总数	性别(例)		年龄[岁，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	下盏解剖结构(±s)
组别	总数	男	女	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	IPA(°)	盏颈长度(mm)	盏颈宽度(mm)	盏颈宽度/盏颈长度比值
A组	18	8	10	55±15	23.0±2.9	2.51±0.29	57±23	11.6±3.7	7.2±2.5	0.63±0.07
B组	22	13	9	53±12	22.2±2.2	2.43±0.23	67±21	11.4±3.1	6.8±2.0	0.60±0.09
C组	38	25	13	50±12	22.8±2.9	2.57±0.24	55±21	13.1±2.9	7.9±2.3	0.59±0.08
统计值		χ² =2.300		F=1.194	F=0.494	F=2.055	F=2.137	F=2.466	F=1.616	F=0.601
P值		0.371		0.309	0.135	0.135	0.125	0.092	0.205	0.551

表2 三组患者术中术后情况的比较

	例数	手术时间[min，(±s)]	Ⅰ期结石清除率(%)	术后发热(例)	低热(体温≤38℃，例)	中高热(体温>38℃，例)	住院时间[d，(±s)]	住院费用[元，(±s)]
A组	18	95±14	77.78	2	2	0	2.61±0.61	16184±7240
B组	22	106±110	72.73	8	5	3	3.27±0.98	14401±6310
C组	38	88±15	84.21	11	8	3	4.58±1.08	14834±1088
统计值		F=11.999	χ² =1.169	χ² =3.363	χ² =1.018	χ² =2.597	F=29.219	F=20.928
P值		<0.001	0.557	0.186	0.601	0.273	<0.001	<0.001

表2 三组患者术中术后情况的比较

	例数	手术时间[min，(±s)]	Ⅰ期结石清除率(%)	术后发热(例)	低热(体温≤38℃，例)	中高热(体温>38℃，例)	住院时间[d，(±s)]	住院费用[元，(±s)]
A组	18	95±14	77.78	2	2	0	2.61±0.61	16184±7240
B组	22	106±110	72.73	8	5	3	3.27±0.98	14401±6310
C组	38	88±15	84.21	11	8	3	4.58±1.08	14834±1088
统计值		F=11.999	χ² =1.169	χ² =3.363	χ² =1.018	χ² =2.597	F=29.219	F=20.928
P值		<0.001	0.557	0.186	0.601	0.273	<0.001	<0.001

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Clinical efficacy of presetting double J tube and using ureteral access sheath in ureteroscopic lithotripsy in the treatment of renal pelvis calculi

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Clinical efficacy of presetting double J tube and using ureteral access sheath in ureteroscopic lithotripsy in the treatment of renal pelvis calculi