杜洲舸　汤春波　祁洪刚　周酉枫　齐　勇　周　永宁波市泌尿肾病医院泌尿外科，浙江宁波　315100

钬激光碎石术治疗上尿路结石的疗效及肾盂内压与术后感染的临床研究

杜洲舸汤春波祁洪刚周酉枫▲齐勇周永
宁波市泌尿肾病医院泌尿外科，浙江宁波315100

目的探讨上尿路结石行输尿管软镜钬激光碎石术的效果及探讨肾盂内压与术后感染的关系。 方法选择2014年8月～2015年8月在我院进行治疗的上尿路结石患者86例进行研究，对入选患者根据是否发生感染进行分组，分为感染组（n=36）、未感染组（n=50），观察比较感染组与未感染组患者的手术时间、肾盂内压、灌注泵流量、C反应蛋白（CRP）、白细胞计数。结果86例患者中，80例均顺利放置镜鞘并置入输尿管软镜，一次进镜成功率为93.0%（80/86）；软镜进镜后98.75%（79/80）成功寻及结石；感染组的肾盂内压、灌注泵流量均显著高于未感染组，差异有统计学意义（P＜0.05）。感染组患者血CRP水平、白细胞计数均显著高于未感染组，差异有统计学意义（P＜0.05）。但两组手术时间比较，差异无统计学意义（P＞0.05）。结论输尿管软镜钬激光碎石术治疗上尿路结石碎石成功率高、并发症少，另一方面，肾盂内压升高易引起术后感染，应密切监测肾盂内压，有利于提高输尿管软镜钬激光碎石术的安全性。

上尿路结石；钬激光碎石术；肾盂内压；术后感染

［Abstract］Objective To discuss the effect of f1exib1e ureteroscopic ho1mium 1aser 1ithotripsy in treatment of upper urinary tract ca1cu1i and to exp1ore the re1ation between intrape1vic pressure and postoperative infection.Methods 86 patients with upper urinary tract ca1cu1i treated in our hospita1 from August 2014 to August 2015 were se1ected and divided based on infection condition into the infection group（n=36）and the non-infection group（n=50）.The operation duration，intrape1vic pressure，f1ow of perfusion pump，CRP，and WBC were observed and compared between two groups. Results Scope sheath and f1exib1e ureteroscope were successfu11y p1aced of 80 cases in the 86 patients，first-time success rate was 93.0%（80/86），and 98.75%（79/80）of these cases ca1cu1i were successfu1 detected.The intrape1vic pressure and f1ow of perfusion pump were significant1y higher in the infection group than in the non-infection group，there was significant difference（P＜0.05）.The 1eve1s of CRP and WBC were significant1y higher in the infection group than in the non-infection group，there was significant difference（P＜0.05）.There was no significant difference in operation duration between two groups（P＞0.05）.Conclusion F1exib1e ureteroscopic ho1mium 1aser 1ithotripsy has high success rate in treatment of upper urinary tract ca1cu1i with 1ow incidence of comp1ications.Enhanced intrape1vic pressure may cause postoperative infection，which，therefore，shou1d be carefu11y monitored to improve the safety of f1exib1e ureteroscopic ho1mium 1aser 1ithotripsy.

［Key words］Upper urinary tract ca1cu1i；Ho1mium 1aser 1ithotripsy；Intrape1vic pressure；Postoperative infection

上尿路结石是常见病、多发病，目前治疗上尿路结石的方法主要有体外冲击波碎石术（extracorporea1 shock-wave 1ithotripsy，ESWL）、经皮肾镜碎石术（percutanous nephro1ithotomy，PCNL）、输尿管镜气压弹道碎石术（URL）等。近年来随着微创外科技术的发展，上尿路结石的治疗方法已由传统的开放性手术转为以微创治疗为主。……