Clinical Analysis of Flexible Ureteroscope in Solitary Kidney and Non-solitary Kidney Stones
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摘要:
目的 探讨输尿管软镜碎石术在孤立肾与非孤立肾结石中的临床疗效。 方法 收集了昆明医科大学第二附属医院泌尿外科2018年1月至2019年4月孤立肾肾结石20例和非孤立性肾肾结石48例患者，孤立肾患者20例，男性14例，女性6例，年龄平均为（51.05±9.49）岁，结石直径在0.7～2.0 cm，平均1.34 cm，其中右肾结石9例，左肾结石11例，非孤立肾患者48例，男性30例，女性18例，年龄23～64岁，平均（51.75±7.68）岁，结石直径在0.7～2.0 cm，平均1.46 cm，右肾结石27例，左肾结石21例，所有患者的麻醉方式均为全麻，在超滑黑色导丝引导下先放入鞘后，输尿管软镜进入，其中6例未能置入输尿管软鞘，顺着导丝进入，寻找肾盂结石，将结石击碎，观察两组的手术时间、住院天数、结石清除率（治疗1月后）、术后并发症等相关情况。 结果 孤立组患者手术平均时间（72.10±8.20） min，住院平均天数（3.40±1.04） d，SFR（治疗1月后）为80%（16/20），并发症为20.00%（4/20），非孤立组患者手术平均时间（71.93±10.00） min，住院平均天数（3.35±1.06） d，SFR（治疗1月后）为75%（36/48），并发症为14.58%（7/48），两组患者在手术时间、住院天数、SFR（1月后）、并发症方面，差异无统计学意义（P > 0.05），孤立组患者术后1月的肾功能与术前对比较，差异有统计学意义（P < 0.05），非孤立组患者术后肾功能较术前变化，差异无统计学意义（P > 0.05）。 结论 输尿管软镜碎石术在孤立肾和非孤立肾结石中治疗具有可行性、相对安全、结石清除率较高及感染率低的优点。 Abstract:Objective To evaluate the clinical effect of flexible ureteroscope lithotripsy on solitary and non-solitary renal calculi. Methods We collected 20 cases of solitary renal calculi and 48 cases of non-solitary renal calculi in the second affiliated hospital of kunming medical university between January 2018 and April 2019. In 20 patients with solitary renal calculi, there were 14 male cases, 6 female cases, the average age was （51.05±9.49） years, the calculi was 0.7～2.0 cm in diameter, an average of 1.34 cm, there were 9 cases of right kidney stones, 11 cases of left kidney stones. In 48 patients with non-solitary renal calculi, there were 30 male cases of male and 18 female cases, aged 23～64, the average （51.75±7.68） years of age, the Calculi was in 0.7～2.0 cm in diameter, an average of 1.46 cm, there were 27 cases of right kidney stones and 21 cases of left kidney stones. All patients received general anesthesia, Under the guidance of super smooth black guide wire, the sheath was put in first and then the flexible ureteroscope was put in. Among them, 6 cases failed to put in the flexible ureteral sheath and entered along the guide wire to find the renal pelvis stones and smash them. Then we observed the operation time, hospitalization days, stone clearance rate （after 1 month of therapy）, and the postoperative complications in the two groups. Results In the solitary renal calculi group, the average operation time was （72.10±8.20） min, average hospitalization days was （3.40±1.04） d, SFR after 1 month of therapy was 80% （16/20）, the incidence of complications was 20.00% （4/20）, in the non-solitary renal calculi group, the average operation time was （71.93±10.00） min, average hospitalization days was （3.35±1.06） d, SFR after 1 month of therapy was 75% （36/48）, the incidence of complications was 14.58% （7/48）. There were no statistically significant differences between the two groups in terms of operation time, length of stay, SFR（after 1 month） and complications （P > 0.05）. The renal function of the solitary renal calculi group one month after surgery was statistically significant compared with that before surgery （P < 0.05）, and the renal function of the non-solitary renal calculi group was not significantly different from that before surgery （P > 0.05）. Conclusion Flexible ureteroscope lithotripsy has the advantages of feasibility, relative safety, high stone clearance rate and low infection rate in the treatment of isolated kidney stones and non-isolated kidney stones. -
Key words:
- Flexible ureteroscope /
- Solitary kidney /
- Renal calculi /
- Stone-free rate
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表 1 两组手术指标比较（
$\bar x \pm s $ ）Table 1. Comparison of surgical indexes between the two groups （
$ \bar x \pm s$ ）项目 合计 孤立组 非孤立组 t/χ2 P 例数（n） 68 20 48 手术时间（min） 71.98 ± 9.45 72.10 ± 8.20 71.93 ± 10.00 0.06 0.94 住院天数（d） 3.36 ± 1.04 3.40 ± 1.04 3.35 ± 1.06 0.16 0.87 SFR术后1月（%） 76.47（52/68） 80（16/20） 75（36/48） 1.65 0.10 并发症（%） 16.17（11/68） 20.00（4/20） 14.58（7/48） 0.78 0.08 
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表 2 两组术前、术后1月肌酐比较（
$\bar x \pm s $ ）Table 2. Comparison of pre-operative，post-operative 1 month creatinine between the two groups （
$\bar x \pm s $ ）组别 术前 术后1月 t P 两组合计平均值（μmol/L） 98.7 ± 44.21 85.75 ± 11.47 1.78 0.127 孤立组平均值（μmol/L） 133.55 ± 69.90 94.35 ± 15.64 9.98 0.002 非孤立组平均值（μmol/L） 84.25 ± 16.02 82.16 ± 6.65 0.69 0.423
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