[1]胡豪,陈欣,蒋立,等.一期输尿管软镜钬激光碎石术治疗≤2 cm单侧上尿路结石的临床研究[J].第三军医大学学报,2018,40(12):1148-1154.
 HU Hao,CHEN Xin,JIANG Li,et al.Efficacy and safety of same-session flexible ureteroscopic lithotripsy for unilateral upper urinary tract calculi 2 cm or smaller[J].J Third Mil Med Univ,2018,40(12):1148-1154.
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一期输尿管软镜钬激光碎石术治疗≤2 cm单侧上尿路结石的临床研究(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第12期
页码:
1148-1154
栏目:
临床医学
出版日期:
2018-06-30

文章信息/Info

Title:
Efficacy and safety of same-session flexible ureteroscopic lithotripsy for unilateral upper urinary tract calculi 2 cm or smaller
作者:
胡豪陈欣蒋立罗生军唐伟
重庆医科大学附属第一医院泌尿外科
Author(s):
HU Hao CHEN Xin JIANG Li LUO Shengjun TANG Wei

Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

关键词:
输尿管软镜肾结石输尿管结石
Keywords:
flexible ureteroscopy renal calculi ureteral calculi
分类号:
R181.32;R454.2;R693.4
文献标志码:
A
摘要:

目的对比研究术前免留置输尿管支架管的一期输尿管软镜与留置输尿管支架管的二期输尿管软镜钬激光碎石术的相关指标,探讨一期输尿管软镜钬激光碎石术治疗单侧上尿路结石的有效性和安全性。方法回顾性分析2016年1月至2017年6月我院收治的≤2 cm单侧肾及输尿管上段结石行输尿管软镜钬激光碎石术患者的临床资料,240例患者符合纳入标准,其中一期手术组和二期手术组各120例。比较两组患者手术时间、软镜鞘置入成功率、碎石成功率、术后住院时间、术后并发症率、术后1个月结石清除率。结果两组患者手术时间、软镜鞘置入成功率、碎石成功率、术后住院时间、术后并发症发生率、术后1个月结石清除率比较差异均无统计学意义(P>0.05)。两组住院次数及费用相比,术前免留置输尿管支架管的一期输尿管软镜钬激光碎石术能减少患者住院次数及费用。结论一期输尿管软镜与二期输尿管软镜钬激光碎石术在治疗≤2 cm单侧上尿路结石中具有相似的安全性和有效性。

Abstract:

ObjectiveTo evaluate the efficacy and safety of same-session flexible ureteroscopy (f-URS) with holmium laser without preoperative ureteral stent placement for treatment of unilateral upper urinary tract calculi 2 cm or smaller in comparison with staged flexible ureteroscopy with preoperative ureteral stent placement. MethodsThe clinical data were retrospectively analyzed for 240 patients undergoing unilateral fURS with holmium laser for unilateral renal and proximal urinary calculi 2 cm or smaller in our department between January, 2016 and June, 2017. Of these patients, 120 received same-session unilateral f-URS surgery without a preexistent ureteral stent and the other 120 underwent staged surgery with preoperative ureteral stent placement. The operation time, the success rates of ureteral access sheath placement and lithotripsy, postoperative hospital stay, postoperative complication rate, and the stone-free rate (SFR) at 1 month after the operation were compared between the  2 groups. ResultsNo significant differences were found between the 2 groups in the operation time, success rate of ureteral access sheath placement, success rate of lithotripsy, postoperative hospital stay, postoperative complication rate, or the stone-free rate ( SFR) at 1 month postoperatively (P>0.05). The patients receiving same-session ureteroscopy without a preexistent ureteral stent, however, had fewer hospital admissions with lower hospital expenditure than those receiving staged ureteroscopy with preoperative ureteral stent placement. ConclusionSamesession flexible ureteroscopy without a preexistent ureteral stent and staged surgery with preoperative ureteral stent placement have similar efficacy and safety for treatment of unilateral upper urinary tract calculi 2 cm or smaller.

参考文献/References:

[1]TüRK C, NEISIUS A, PETRIK A, et al. Guidelines on urolithiasis[J]. Urology, 2015, 80(1): 1-4.
[2]曾国华, 麦赞林, 夏术阶, 等.中国成年人群尿石症患病率横断面调查[J].中华泌尿外科杂志, 2015, 36(7): 528-532. DOI: 10.3760/cma.j.issn.10006702.2015.07.014.
ZENG G H, MAI Z L, XIA S J, et al. A crosssectional survey of urolithiasis prevalence in China[J].Chin J Urol 2015, 36(7): 528-532. DOI: 10.3760/cma.j.issn.10006702. 2015.07.014.
[3]GIUSTI G, PROIETTI S, VILLA L, et al. Current standard technique for modern flexible ureteroscopy: tips and tricks[J].Eur Urol, 2016, 70(1): 188-194. DOI: 10.1016/j.eururo.2016.03.035.
[4]SANGUEDOLCE F, LIATSIKOS E, VERZE P, et al. Use of flexible ureteroscopy in the clinical practice for the treatment of renal stones: results from a large european survey conducted by the EAU young academic urologistsworking party on endourology and urolithiasis[J]. Urolithiasis, 2014, 42(4): 329-334. DOI: 10.1007/s002400140659y.
[5]梅骅, 陈凌武, 高新.泌尿外科手术学[M].北京: 人民卫生出版社, 2008: 154-155.
MEI H, CHEN L W, GAO X. Department of urology surgery[M]. Beijing: People’s Medical Publishing House, 2008: 154-155.
[6]李涛, 李权, 刘建河.一期与分期输尿管软镜治疗双侧上尿路结石的疗效比较[J]. 中国微创外科杂志, 2016, 16(9): 816-819.DOI: 10.3969/j.issn.10096604.2016.09.013.
LI T, LI Q, LIU J H.Samesession bilateral versus staged unilateral flexible ureteroscopic lithotripsy for upper urinary system stones[J].Chin J Min Inv surg, 2016, 16(9): 816-819.DOI: 10.3969/j.issn.10096604.2016.09.013.
[7]FAN S, GONG B, HAO Z, et al. Risk factors of infectious complications following flexible ureteroscope with a holmium laser: a retrospective study[J]. Int J Clin Exp Med, 2015, 8(7): 11252-11259.
[8]李贵忠, 满立波, 王海, 等. 比较降钙素原、C反应蛋白和血白细胞计数在经皮肾镜取石术后脓毒血症诊断中的价值[J]. 中华泌尿外科杂志, 2017, 38(1): 42-46.
LI G Z, MAN L B, WANG H, et al. The value of procalcitonin compared to Creactive protein and blood white cell count in early detection of sepsis following percutaneous nephrolithotomy[J]. Chin J Urol, 2017, 38(1): 42-46.
[9]那彦群, 叶章群, 孙颖浩, 等.中国泌尿外科疾病诊断治疗指南手册(2014版)[M].北京: 人民卫生出版社, 2014: 152.
NA Y Q, YE Z Q, SUN Y H, et al. Chinese department of urology guide for diagnosis and treatment of disease (2014 Edition) [M].Beijing: People’s Medical Publishing House, 2014: 152.
[10]李毅, 陈刚, 文爽, 等.输尿管软镜钬激光碎石术治疗长径≥2 cm的肾结石68例临床分析[J]. 第三军医大学学报, 2016, 38(13): 1547-1551. DOI: 10.16016/j.10005404.201512188.
LI Y, CHEN G, WEN S, et al. Flexible ureteroscopy with holmium laser lithotripsy for renal stones 2 cm or greater: report of 68 cases[J].J Third Mil Med Univ, 2016, 38(13): 1547-1551. DOI: 10.16016/j.10005404.201512188.
[11]常启跃, 叶茂, 罗琦, 等.输尿管软镜治疗>2 cm肾和输尿管上段结石的疗效和安全性评价[J].第三军医大学学报, 2016, 38(3): 302-306. DOI: 10.16016/j.10005404.201508111.
CHANG Q Y, YE M, LUO Q, et al. Flexible ureteroscopic lithotripsy for intrarenal and proximal ureteral calculi in diameter of >2 cm: a clinical report for efficacy and safety[J].J Third Mil Med Univ, 2016, 38(3): 302-306. DOI: 10.16016/j.10005404.201508111.
[12]SCHOENTHALER M, WILHELM K, HEIN S, et al. Ultramini PCNL versus flexible ureteroscopy: a matched analysis of treatment costs (endoscopes and disposables) in patients with renal stones 1020 mm[J]. World J Urol, 2015, 33(10): 1601-1605. DOI: 10.1007/s0034501514894.
[13]KUMAR A, VASUDEVA P, NANDA B, et al. A prospective randomized comparison between shock wave lithotripsy and flexible ureterorenoscopy for lower caliceal stones ≤2 cm: a singlecenter experience[J]. J End, 2015, 29(5): 575-579. DOI: 10.1089/end.2013.0473.
[14]ASSIMOS D, CRISCI A, CULKIN D, et al. Preoperative JJ stent placement in ureteric and renal stone treatment: results from the clinical research office of endourological society (CROES) ureteroscopy (URS) global study[J]. BJU Int, 2016, 117(4): 648-654. DOI: 10.1111/bju.13250.
[15]杨炜青, 李逊, 何永忠, 等.输尿管软镜碎石术前留置双J管的随机对照研究[J].中华腔镜泌尿外科杂志(电子版), 2016, 10(2): 26-29. DOI: 10.3877/cma.j.issn.16743253.2016.02.008.
YANG W Q, LI X, HE Y Z, et al. A randomized controlled clinical study on preoperative double J tube placement in flexible ureteroscopic lithotripsy [J].Chin J End(Electron Ed), 2016, 10(2): 26-29. DOI: 10.3877/cma.j.issn.16743253.2016.02.008.
[16]WANG J, ZHANG X, ZHANG T, et al. The role of solifenacin, as monotherapy or combination with tamsulosin in ureteral stentrelated symptoms: a systematic review and metaanalysis [J].World J Urol, 2017, 35(11): 1669-1680. DOI: 10.1007/s0034501720513.
[17]DESAI M, SUN Y, BUCHHOLZ N, et al. Treatment selection for urolithiasis: percutaneous nephrolithomy, ureteroscopy, shock wave lithotripsy, and active monitoring[J]. World J Urol, 2017, 35(9): 1395-1399. DOI: 10.1007/s0034501720308.
[18]TAUBER V, WOHLMUTH M, HOCHMUTH A, et al. Efficacy management of urolithiasis: flexible ureteroscopy versus extracorporeal shockwave lithotripsy[J]. Urol Int, 2015, 95(3): 324-328. DOI: 10.1159/000439356.
[19]DESSYN J F, BALSSA L, CHABANNES E, et al. Flexible ureterorenoscopy for renal and proximal ureteral stone in patients with previous ureteral stenting: impact on stonefree rate and morbidity[J]. J End, 2016, 30(10): 1084-1088. DOI: 10.1089/end.2016.0045.
[20]LILDAL S K, NRREGAARD R, ANDREASSEN K H, et al. Ureteral access sheath influence on the ureteral wall evaluated by cyclooxygenase2 and tumor necrosis factorα in a porcine model[J]. J End, 2017, 31(3): 307-313. DOI: 10.1089/end.2016.0773.
[21]中华医学会泌尿外科分会, 中国泌尿系结石联盟.软性输尿管镜术中国专家共识[J].中华泌尿外科杂志, 2016, 37(8): 561-565.
China Medical Association Department of Urology branch, Chinese urolithiasis Consortium. Chinese expert consensus on soft ureteroscopy[J]. Chin J Urol, 2016, 37(8): 561-565.
[22]ZHANG J, XU C, HE D, et al. Flexible ureteroscopy for renal stone without preoperative ureteral stenting shows good prognosis [J]. Peer J, 2016, 4: e2728. DOI: 10.7717/peerj.2728.
[23]蔡万松, 蒋祥新, 闻立平.术前免留置双J管一期输尿管软镜治疗肾结石的临床研究[J]. 中国内镜杂志, 2016, 22(4): 58-62.
CAI W S, JIANG X X, WEN L P.Clinical application of flexible ureteroscopy lithotripsy in treatment of renal calculi without preexistent ureteral stent[J].Chin J End, 2016, 22(4): 58-62.

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更新日期/Last Update: 2018-07-03