[1]李尧 李权 何奇瑞 齐隽 刘建河*.输尿管软镜下钬激光碎石术后输尿管石街形成的处理时机[J].中国微创外科杂志,2020,01(1):39-41.
　Li Yao,Li Quan,He Qirui,et al.The Timing of Treatment for Steinstrasse After Flexible Ureteroscopic Lithotripsy With Holmium Laser[J].Chinese Journal of Minimally Invasive Surgery,2020,01(1):39-41.
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输尿管软镜下钬激光碎石术后输尿管石街形成的处理时机()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年1期
页码:
39-41
栏目:
临床研究
出版日期:
2020-03-25

文章信息/Info

Title:
The Timing of Treatment for Steinstrasse After Flexible Ureteroscopic Lithotripsy With Holmium Laser
作者:
李尧 李权 何奇瑞 齐隽 刘建河*
（上海交通大学医学院附属新华医院泌尿外科，上海200092）
Author(s):
Li Yao;  Li Quan;  He Qirui;  et al.
Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
关键词:
肾结石; 输尿管结石; 输尿管石街; 输尿管软镜; 钬激光
Keywords:
Renal calculi; Ureteral calculi; Steinstrasse; Flexible ureteroscopy; Holmium laser
文献标志码:
A
摘要:
目的探讨输尿管软镜碎石术（flexible ureteroscopic lithotripsy，FURL）后输尿管石街形成的腔内微创手术处理的时机。方法2011年2月～2017年6月我院采用FURL处理经选择的直径>2 cm肾或输尿管上段结石388例，术后复查腹部平片（KUB）或CT示输尿管石街56例，石街长度1.5～4.6 cm，按照Coptcoat石街分型，Ⅰ型16例，Ⅱ型12例，Ⅲ型28例。积极保守药物排石治疗4～8周后，石街未完全排除患者行输尿管镜钬激光碎石取石（ureteroscopic lithotripsy，URL）处理。结果56例输尿管石街保守药物排石治疗4周后，仅18例输尿管末段短距离石街（Ⅰ型16例，Ⅱ型2例）顺利排出，其余38例（Ⅱ型10例，Ⅲ型28例）术后4～8周行URL，其中31例术后保守治疗4周后行URL，5例保守治疗6周后行URL，2例保守治疗8周后行URL。38例输尿管石街全部一期URL碎石取石成功，手术时间32~110 min，平均56 min。14例因术后输尿管黏膜严重水肿再次留置输尿管支架管。无一例发生术中严重并发症，术后3例出现高热，经积极抗感染治疗后好转。术后住院2~5 d，平均3 d。结论对于FURL术后Ⅱ或Ⅲ型（长距离石街或者石街中混合有较大体积结石碎片）输尿管石街，长时间停留结石碎片的局部刺激容易出现黏膜水肿，自行排石效果更不理想，建议在术后4周积极采用URL清除石街，及时解除梗阻，以减少进一步的肾功能损害。
Abstract:
ObjectiveTo investigate the timing of treatment of steinstrasse after flexible ureteroscopic lithotripsy (FURL) with holmium laser.MethodsFrom February 2011 to June 2017, 388 patients with renal or ureteral calculi more than 2 cm in diameter underwent FURL with holmium laser by the same surgeon in our hospital. Postoperative reexaminations of Xray or CT scanning showed steinstrasse formation with a length of 1.5-4.6 cm. According to the Coptcoat’s steinstrasse classification, there were type Ⅰ, Ⅱ, and Ⅲ steinstrasse in 16, 12, and 28 patients, respectively. Patients who had no responds to 4-8 weeks of conservative treatment were subjected to ureteroscopic lithotripsy(URL).ResultsConservative management was successful in 18 cases of ureteral shortdistance steinstrasse (16 cases of type Ⅰ and 2 cases of type Ⅱ) after 4 weeks. The remaining 38 cases (10 cases of type Ⅱ and 28 cases of type Ⅲ) were successfully treated with URL at 4-8 weeks postoperatively, including 31 cases treated at 4 weeks postoperatively, 5 cases at 6 weeks, and 2 cases at 8 weeks. The operation time ranged from 32 to 110 min with a mean of 56 min. There were 14 cases of postoperative ureteral mucosal severe edema needing a reindwelling ureteral stent. No major intraoperative complications were identified. Postoperative highgrade fever was observed only in 3 patients, and all these patients were successfully treated conservatively.The patients were discharged from hospital in 2-5 days (mean, 3 days).ConclusionsFor type Ⅱ and Ⅲ steinstrasse (long distance steinstrasse or mixed with large volume stone fragments) after FURL, local stimulation of stone fragments staying for a long time is prone to mucosal edema, and the effect of self stone removal is unsatisfactory. It is suggested that URL should be actively used to remove steinstrasse in 4 weeks after operation, and the obstruction should be relieved in time to reduce further renal function damage.

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备注/Memo

备注/Memo:
*通讯作者，Email：liujianhe@Xinhuamed.com.cn
更新日期/Last Update: 2020-04-16