输尿管软镜在治疗体外冲击波碎石失败的飞行员肾脏小结石中的应用
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摘要
目的:观察输尿管软镜技术在治疗体外碎石失败的飞行员肾脏小结石中的效果。方法:回顾分析2009年10月~2015年9月采用体外冲击波碎石(ESWL)治疗失败后进行输尿管软镜手术的26例单侧肾脏小结石飞行人员病例资料。结果:所有患者均为男性,年龄22~48岁。术前CT提示肾脏小结石,左肾11例,右肾15例,结石长径0.2~0.8cm,其中12例患者镜下发现结石,采用激光光纤将肾脏小结石击碎,部分结石碎片采用套石网篮取出,部分结石碎屑术后经尿路自行排出;14例患者镜下确诊肾乳头黏膜下钙化,未予特殊处理。术后随访6~24个月,肾乳头钙化斑较术前未见明显变化。结论:对于体外碎石治疗失败的飞行员上尿路结石,输尿管软镜手术是安全有效的治疗手段。
Objective:To observe the effect of flexible ureteroscopy technology treating small kidney stone in pilots who failed in extracorporeal shock wave lithotripsy.Methods:The clinical data of 26 pilots with unilateral small kidney stones were retrospectively analyzed from October 2009 to September 2015.All cases failed in extracorporeal shock wave lithotripsy,and flexible ureteroscopy surgery was given finally.Results:All patients were male,from 22 to 48years old,and all were diagnosed as unilateral small kidney stones by computed tomography(CT),with 11 lesions in the left kidney,and 15 in right.The major diameter of stone ranged from 0.2to 0.8cm.Among the 26 cases,12patients' kidney stones were found by flexible ureteroscopy,and were shattered by the Holmium laser.Besides,14 patients were diagnosed as renal papilla calcifications by flexible ureteroscopy,without any treatment.Patients were all qualified to fly,and flew safely after 6to 24months' follow-up.As for renal papilla calcifications,there was no significant difference before and after operation.Conclusions:For pilots with small kidney stones,if they fail in extracorporeal shock wave lithotripsy,flexible ureteroscopy could be a safe and effective therapeutic method.
Objective:To observe the effect of flexible ureteroscopy technology treating small kidney stone in pilots who failed in extracorporeal shock wave lithotripsy.Methods:The clinical data of 26 pilots with unilateral small kidney stones were retrospectively analyzed from October 2009 to September 2015.All cases failed in extracorporeal shock wave lithotripsy,and flexible ureteroscopy surgery was given finally.Results:All patients were male,from 22 to 48years old,and all were diagnosed as unilateral small kidney stones by computed tomography(CT),with 11 lesions in the left kidney,and 15 in right.The major diameter of stone ranged from 0.2to 0.8cm.Among the 26 cases,12patients' kidney stones were found by flexible ureteroscopy,and were shattered by the Holmium laser.Besides,14 patients were diagnosed as renal papilla calcifications by flexible ureteroscopy,without any treatment.Patients were all qualified to fly,and flew safely after 6to 24months' follow-up.As for renal papilla calcifications,there was no significant difference before and after operation.Conclusions:For pilots with small kidney stones,if they fail in extracorporeal shock wave lithotripsy,flexible ureteroscopy could be a safe and effective therapeutic method.
引文
[1]刘彦志,王松林,姜建荣.1995~1999年度飞行人员住院疾病谱分析.航空军医,2003,31(2):51-52.
[2]徐先荣,付兆君,尹欣,等.歼击机飞行员住院疾病谱分析.中华航空天医学杂志,2005,16(2):135-138.
[3]孙斌,郭和清,李建业,等.飞行员肾脏小结石带石飞行初步观察.中华航空航天医学杂志,2013,24(1):39-42.
[4]Gammill MA,Syoc DV.Renal and ureteral stones//AirForce Surgeon General.Washington:Department of Air Force,2011:727-735.
[5]李建业,严景民,刘红明,等.输尿管软镜在单座歼击机飞行员肾脏小结石治疗中的应用.中华航空航天医学杂志,2014,25(3):180-183.
[6]金荣连,郭宝玉,秦建民,等.年度大体检发现飞行人员泌尿系统疾病106例报告.航空军医,1995,23(1):26-27.
[7]郭和清,李建业,周高标.微创腔镜手术与体外冲击波碎石术治疗飞行人员上尿路结石临床疗效的对比研究.解放军医学杂志,2013,38(12):1015-1018.
[8]戴伟川,曹欣,王进霞,等.飞行人员大体检中B型超声特点分析.人民军医,2003,46(11):625-626.
[9]那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南.北京:人民卫生出版社,2013:129-165.
[10]陈凯凯,郭和清,穆大为,等.模拟加速度对肾草酸钙结石模型大鼠氧化应激的影响.东南国防医药,2016,18(1):10-12.
[11]陈元浩,郭和清,孙斌,等.离心加速度对大鼠尿Tamm-horsfall蛋白浓度的影响及其与尿路结石成因的关系.中华医学杂志,2014,94(14):1105-1107.
[12]郑杰,郭和清,潘广新,等.缺氧或+Gz暴露对大鼠肾结石形成影响的实验研究.中华航空航天杂志,2012,23(2):98-101.
[13]Glowacki LS,Beecroft ML,Cook RJ,et al.The Natural History of Asymptomatic Urolithiasis.J Urol,1992,147(2):319-321.
[14]Boyce CJ,Pickhardt PJ,Lawrence EM,et al.Prevalence of Urolithiasis in Asymptomatic Adults:Objective Determination Using Low Dose Noncontrast Computerized Tomography.J Urol,2010,183(3):1017-1021.
[15]刘红巾,徐先荣,程军,等.2003-2008年歼击机飞行员飞行不合格疾病谱分析.中华航空航天医学杂志,2009,20(3):173-176.
[16]McCormick TJ,Lyons TJ.Medical Causes of In-Flight Incapacitation:USAF Experience 1978-1987.Aviat Space Environ Med,1991,62(9Pt 1):884-887.
[17]DeJohn CA,Wolbrink AM,Larcher JG.In-flight medical incapacitation and impairment of airline pilots.Aviat Space Environ Med,2006,77(10):1077-1079.
[18]梁谷米,余清平.飞行人员尿石症临床特点和医学鉴定.中华航空航天医学杂志,2006,17(3):222-225.
[2]徐先荣,付兆君,尹欣,等.歼击机飞行员住院疾病谱分析.中华航空天医学杂志,2005,16(2):135-138.
[3]孙斌,郭和清,李建业,等.飞行员肾脏小结石带石飞行初步观察.中华航空航天医学杂志,2013,24(1):39-42.
[4]Gammill MA,Syoc DV.Renal and ureteral stones//AirForce Surgeon General.Washington:Department of Air Force,2011:727-735.
[5]李建业,严景民,刘红明,等.输尿管软镜在单座歼击机飞行员肾脏小结石治疗中的应用.中华航空航天医学杂志,2014,25(3):180-183.
[6]金荣连,郭宝玉,秦建民,等.年度大体检发现飞行人员泌尿系统疾病106例报告.航空军医,1995,23(1):26-27.
[7]郭和清,李建业,周高标.微创腔镜手术与体外冲击波碎石术治疗飞行人员上尿路结石临床疗效的对比研究.解放军医学杂志,2013,38(12):1015-1018.
[8]戴伟川,曹欣,王进霞,等.飞行人员大体检中B型超声特点分析.人民军医,2003,46(11):625-626.
[9]那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南.北京:人民卫生出版社,2013:129-165.
[10]陈凯凯,郭和清,穆大为,等.模拟加速度对肾草酸钙结石模型大鼠氧化应激的影响.东南国防医药,2016,18(1):10-12.
[11]陈元浩,郭和清,孙斌,等.离心加速度对大鼠尿Tamm-horsfall蛋白浓度的影响及其与尿路结石成因的关系.中华医学杂志,2014,94(14):1105-1107.
[12]郑杰,郭和清,潘广新,等.缺氧或+Gz暴露对大鼠肾结石形成影响的实验研究.中华航空航天杂志,2012,23(2):98-101.
[13]Glowacki LS,Beecroft ML,Cook RJ,et al.The Natural History of Asymptomatic Urolithiasis.J Urol,1992,147(2):319-321.
[14]Boyce CJ,Pickhardt PJ,Lawrence EM,et al.Prevalence of Urolithiasis in Asymptomatic Adults:Objective Determination Using Low Dose Noncontrast Computerized Tomography.J Urol,2010,183(3):1017-1021.
[15]刘红巾,徐先荣,程军,等.2003-2008年歼击机飞行员飞行不合格疾病谱分析.中华航空航天医学杂志,2009,20(3):173-176.
[16]McCormick TJ,Lyons TJ.Medical Causes of In-Flight Incapacitation:USAF Experience 1978-1987.Aviat Space Environ Med,1991,62(9Pt 1):884-887.
[17]DeJohn CA,Wolbrink AM,Larcher JG.In-flight medical incapacitation and impairment of airline pilots.Aviat Space Environ Med,2006,77(10):1077-1079.
[18]梁谷米,余清平.飞行人员尿石症临床特点和医学鉴定.中华航空航天医学杂志,2006,17(3):222-225.
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