输尿管软镜联合钬激光治疗上尿路结石的效果观察

目的探讨输尿管软镜联合钬激光治疗上尿路结石的临床效果。方法选取本院2012年5月-2014年5月收治的上尿路结石患者100例,将患者随机分为观察组和对照组,各50例。观察组采用输尿管软镜联合钬激光治疗,对照组采用传统开放手术治疗,比较两组的碎石成功率、手术时间、住院时间、术中出血量、术后并发症发生率。结果观察组中碎石成功47例（94.0%）,有2例患者因输尿管迂曲、狭窄留置导丝失误转行PCNL手术治疗,1例肾下盏结石患者由于输尿管镜的弯曲度不够而不能实施碎石;对照组碎石成功40例（80.0%）,有6例患者因出血过多停止手术,另4例患者因视野不清晰无法进行手术,两组的碎石成功率比较,差异有统计学意义（P〈0.05）。观察组的手术时间、住院时间短于对照组,术中出血量少于对照组,差异有统计学意义（P〈0.05）。两组患者术中未出现输尿管穿孔、撕脱,败血症等严重并发症,观察组的术后并发症发生率为6.0%,明显低于对照组的18.0%,差异有统计学意义（P〈0.05）。结论输尿管软镜联合钬激光治疗上尿路结石安全高效,术中出血量少,并发症发生率低,患者恢复快,有极大的临床推广价值。

Effect observation of flexible ureteroscope combined with holmium laser treating the upper urinary tract calculi

Objective To explore the clinical effect of flexible ureteroscope combined with holmium laser treating the upper urinary tract calculi. Methods 100 patients with the upper urinary tract calculi treated in our hospital from May2012 to May 2012 were selected and they were divided into the observation group（n=50） and control group（n=50）.The observation group was treated with flexible ureteroscope combined with holmium laser,the control group was treated with traditional open surgery.The success rate of gravel,the operation time,hospital stay,intraoperative bleeding volume,the incidence rate of postoperative complication in the two groups were compared. Results In the observation group,47cases（94.0%） were treated successfully,2 patients were diverted to PCNL operation treatment because of detaining guide wire unsuccessfully for tortuosity and narrow of ureter,1 patient with lower calyceal calculi had no implementation of gravel because bending degree of ureter mirror was not enough.In the control group,40 cases（80.0%） were treated successfully,6 patients were stopped operation because of excessive bleeding,4 patients were given the operation because the vision was not clear,and there was a statistical difference of the success rate of gravel in the two groups（P〈0.05）.The operation time,the hospital stay in the observation group was shorter than that in the control group reapectively,the intraoperative bleeding volume in the observation group was fewer than that in the control group,and there was a statistical difference of the two groups（P〈0.05）.The patients in the two groups did not appear the serious complication such as perforation,avulsion of ureterl,and sepsis and so on,the incidence rate of the observation group（6.0%） was obviously lower than that in the control group（18.0%）,and there was a statistical difference of the two groups（P〈0.05）.Conclusion Flexible ureteroscope combined with holmium laser treating the upper urinary tract calculi is safe and effective with fewe