分期输尿管软镜钬激光碎石术治疗≥4 cm复杂性肾结石的回顾性研究（附389例报道）

Staged flexible ureteroscopy with holmium laser lithotripsy for the treatment of diameter ≥4 cm complex nephrolithiasis: a retrospective study of 389 cases

摘要

目的 探讨分期输尿管软镜钬激光碎石术（flexible ureteroscopic holmium lithotripsy，FURL）治疗复杂性肾结石的安全性和有效性。 方法 回顾性分析2013年1月至2023年12月海军军医大学附属特色医学中心泌尿外科收治的389例单侧大负荷肾结石（直径≥4 cm）患者，分期行输尿管软镜钬激光碎石手术，统计手术次数和时间、住院时间和费用、结石清除率、并发症发生率等；并发症包括发热、尿源性脓毒症（urosepsis）、严重出血和石街等。 结果 所有患者都至少经历2次手术，其中22例患者经历3次手术；1期手术的平均手术时间为（84.60±21.34） min，2期手术的平均手术时间为（89.70±19.17） min，清石率为94.60%，3期手术的平均手术时间为（72.50±17.30） min，清石率为90.90%；有21人次出现发热，其中7例诊断为尿源性脓毒症；76人次出现石街；30人次出现肉眼明显血尿。 结论 分期FURL治疗大负荷结石的方案是安全有效的，略高一些的治疗费用要得到患者理解和同意。

Abstract

Objective To investigate the safety and efficacy of staged flexible ureteroscopy with holmium laser lithotripsy（FURL）for the treatment of complex nephrolithiasis. Methods We retrospectively analyzed 389 patients with unilateral large renal stones（≥4 cm in diameter）who had undergone staged FURL from January 2013 to December 2023. We analyzed the number and duration of procedures performed，the length of hospital stay，the cost of hospitalization，the stone clearance rate，and the incidence of complications（fever，urosepsis，severe hemorrhage，steinstrasse，etc.）. Results Each patient underwent at least two procedures，and 22 patients underwent three procedures. The mean duration of stage-1 procedures was（84.60±21.34） minutes. The mean duration of stage-2 procedures was （89.70±19.17） minutes，with a stone clearance rate of 94.60%. The mean duration of stage-3 procedures was （72.50±17.30） minutes，with a stone clearance rate of 90.90%. There were 21 events of fever（7 cases of urosepsis），76 events of steinstrasse，and 30 events of gross hematuria. Conclusion Staged FURL is safe and effective for treating large stones in the kidney，but its high cost is a concern to the patients.

关键词

输尿管软镜 / 分期 / 肾结石

Key words

flexible ureteroscopy / staged / nephrolithiasis