输尿管镜下钬激光与气压弹道治疗输尿管中下段结石并息肉的疗效比较

目的：比较钬激光与气压弹道碎石治疗输尿管中下段结石并息肉的有效性及安全性。方法：回顾性分析我院2006年1月-2012年12月输尿管镜下治疗输尿管结石患者的临床资料，钬激光碎石组90例，气压弹道碎石组88例，比较两组手术时间、结石排净率及输尿管狭窄的发生率等。结果：两组均无中转开放病例。钬激光碎石一次性粉碎率为100％，一次性取净率为97．8％（88／90）；气压弹道碎石一次性粉碎率为100％，一次性取净率为95．5％（84／88）。钬激光碎石组与气压弹道碎石组结石清除率的差异无统计学意义（P〉0．05）。但钬激光组输尿管穿孔率为8．9％（8／90），气压弹道组为1．1％（1／88）；钬激光组出现输尿管狭窄率为11．1％（10／90），气压弹道组仅2．3％（2／88），差异均有统计学意义（P〈0．05）。结论：输尿管镜下钬激光碎石术和气压弹道碎石术均可有效治疗合并息肉形成的中下段输尿管结石，但气压弹道碎石术的安全性更高。

Comparison of holmium laser and pneumatic lithotripsy treatment for middle and lower ureteral calculi combined with polyps

Objective： To compare the efficacy and safety of holmium： YAG laser and pneumatic lithotripsy in treatment for middle and lower ureteral calculi combined with polyps. Method： From January 2006 to December 2012, totally 178 patiehts with ureteral calculi combined with polyps Underwent ureteroscopic lithotripsy with hol-mium： YAG laser or pneumatic lithotripsy. The ＇data of the patients were analyzed retrospectively. Result： Both groups were successfully completed surgery with no case conversion to open surgery. Single-procedure success rate of lithotripsy was 100% in the patients who were received holmium laser, and 100% in those who underwent pneumatic lithoelast. Single-procedure success of stone-free rate was 97.8% （88/90） in the holmium laser group, which was no significant difference （P〉0.05） with that in the pneumatic lithoclast group 95.5% （84/88）. One （1/88） patient encountered perforation in PL procedure, whereas eight （8/90） patients were observed perforation when underwent HL. There was a significant difference （P〈0.05）. Ten （10/90） cases were seen ureteral stric-ture in holmium laser and two （2/88） cases were detected ureteral stricture in pneumatic lithotripsy, which was a significant difference （P〈0.05）. Conclusion： Both holmium laser and pneumatic lithotripsy are safe and effective in treatment for middle and lower ureteral calculi combined with polyps. However, pneumatic lithotripsy is superi-or to holmium laser.