超细输尿管镜治疗婴幼儿输尿管 中下段结石的临床研究

Superthin-ureteroscopy for the treatment of mid and distal ureteral calculi in infant

摘要:

目的 探讨4.8 F 和4.5 F 两款超细输尿管镜在婴幼儿输尿管中下段结石治疗中的有效性及安全 性。方法 回顾性分析2016 年10 月—2018 年8 月首都医科大学附属北京友谊医院探索性采用超细输尿管镜 （4.8F Micro-URS 和4.5 F ultrathin-URS）治疗34 例婴幼儿输尿管中下段结石患儿的临床资料，将患者分为 4.8F Micro-URS 组和4.5 F ultrathin-URS 组。术前泌尿系CT 平扫确诊输尿管中下段结石。手术采用全身 麻醉，取截石位，应用4.8 F Micro-URS 或4.5 F ultrathin-URS 连接带有延长管的50 ml 注射器，助手人工推 注生理盐水灌注液，直视下进入患侧输尿管，寻找到结石，置入200μm 钬激光光纤行粉末化碎石。分析手术 效果、并发症及预后。结果 4.8 F Micro-URS 组碎石治疗11 例，一次进镜成功率为100%，均未行输尿管口 扩张。手术时间（19.5±11.3）min，灌注液用量（259±423）ml。一期结石清除率为100%。4.5 F ultrathin- URS 组碎石治疗23 例，一次进镜成功率为100%，均未行输尿管口扩张。手术时间（20.2±10.2）min，灌注 液用量（293±229）ml。两组性别比例、年龄、结石大小、手术时间、灌注液用量、术后住院时间、术后发 热及血尿比较，差异无统计学意义（P >0.05）。结论 两款超细输尿管镜联合钬激光治疗婴幼儿输尿管中下 段结石清石率高、安全性好，均是值得推荐的婴幼儿输尿管中下段结石治疗方法。

Abstract:

Objective To demonstrate the efficacy and safety of superthin-ureteroscopy (URS) in the management of mid and distal ureteral stones in the infant population. Methods A total of 34 infants, who had undergone superthin-ureteroscopy (4.8F micro-URS and 4.5F ultrathin-URS) in our center between October 2016 and August 2018 with the indication of mid and distal ureteral calculi which were confirmed by urinary noncontrast computer tomography (CT) scan, were retrospectively evaluated. The procedures were performed with the patient in the lithotomy position under general anesthesia using the standard URS technique with 4.8F micro-URS or 4.5F ultrathin-URS and 200-μm holmium: YAG laser. Demographics, perioperative data, and outcomes were assessed. Results Patients consisted of 8 girls and 26 boys with a mean age of 20.2±9.8 months. The average stone size was 12±6 mm (range, 5-25 mm). All ureteroscopies were performed with no active or passive dilatation. 11 cases were performed by 4.8F micro-URS and 23 cases were treated with 4.5F ultrathin-URS. The average operative time were (19.5±11.3) min and (20.2±10.2) min for these two groups. The average dosage of flushing was (259±423) ml in 4.8F micro-URS group and (293±229) ml in 4.5F ultrathin-URS. Stone-free status was accomplished in these two groups in the final assessment. There were no statistical different between two groups on inoperative time, flushing dosage, duration of hospital stay, one-stage stone free rate and postoperative complication. Conclusions The outcomes of our study show that superthin-ureteroscopy (4.8F micro-URS and 4.5F ultrathin-URS) along with holmium: YAG laser can be used safely and effectively in the treatment of infant mid and distal ureteral stones.