输尿管镜下钬激光联合封堵器碎石术与传统钬激光碎石术治疗输尿管结石临床研究

目的 比较输尿管镜下钬激光联合封堵器碎石术与传统钬激光碎石术治疗输尿管结石的安全性及疗效.方法 回顾性分析2013年1月至2016年5月我院泌尿外科收治的484例临床资料完整的输尿管结石患者的临床诊治资料,按其不同的治疗方法分为观察组198例和对照组286例.观察组患者采用输尿管镜下钬激光联合封堵器碎石术治疗,对照组采用传统钬激光碎石术治疗.比较两组患者的手术时间、住院时间、结石清除率、输尿管损伤、术后发热、结石残留等情况.结果 观察组患者的结石清除率为95.45%,明显高于对照组的70.98%,差异有统计学意义(P<0.05);两组患者平均手术时间相当,但在输尿管中上段结石治疗中,观察组患者的平均手术时间为(38.46±17.33)min,明显短于对照组的(48.62±19.16)min,差异有统计学意义(P<0.05);观察组患者出现输尿管损伤11例(5.56%),对照组26例(9.09%),差异无统计学意义(P>0.05);治疗后共出现结石上移至肾脏33例,33例中对照组占28例,在对照组28例中有17例为输尿管中上段结石,观察组5例均为输尿管中上段结石,差异有统计学意义(P<0.05);观察组有9例(4.55%)术后出现不同程度的发热,明显低于对照组的44例(15.38%),差异有统计学意义(P<0.05).结论 输尿管镜下钬激光联合封堵器碎石术治疗输尿管结石清除率较高,同时可减少体内结石被击碎移入肾脏的几率,且不增加输尿管损伤风险,降低术后发热、残留结石等并发症发生率.

Safety and efficacy of ureteroscopic holmium laser lithotripsy combined with ureteral occluder vs traditional holmium laser lithotripsy for ureteral stones

Objective To investigate the safety and efficacy of ureteroscopic holmium laser lithotripsy com-bined with occluder vs traditional holmium laser lithotripsy for ureteral stones. Methods A total of 484 cases of ureteral calculi in our hospital from April 2013 to February 2016 were divided into observation group (n=198) and control group (n=286) according to the treatment method. The observation group was treated with ureteroscopic holmium laser litho-tripsy combined with occluder, and the control group applied the traditional holmium laser lithotripsy for treatment. The operation time, length of hospital stay, stone clearance rate, ureteral injury, postoperative fever and residual stones were compared between the two groups. Results Stone clearance rate of the observation group was 95.45%, significantly higher than 70.98% in the control group (P<0.05). The operation time of the two groups were similar, but for middle and upper ureteral calculi, operation time in the observation group was significantly shorter than that in control group, (38.46±17.33) min vs (48.62±19.16) min (P<0.05). Ureteral injury was reported in 26 cases (9.09%) in the control group and 11 cases (5.56%) in the observation group (P>0.05). A total of 33 cases had stone migration up to the kidney after treatment, including 28 cases in the control group and 5 cases in the observation group, and 17 of the 28 cases and 5 of the 5 cases had upper ureteral calculi (P<0.05). After operation, 44 cases in the control group and 9 cases in the observa-tion group had varying degrees of fever, and the difference was statistically significant between the two groups (P<0.05). Conclusion Holmium laser lithotripsy combined with ureteral occluder for treatment of ureteral calculi can improve stone clearance rate, reduce the probability of stone migration up to the kidney, reduce postoperative fever and the inci-dence of residual stone, without increasing the risk of ureteral injury.