输尿管软镜钬激光碎石术与输尿管硬镜碎石联合套石篮治疗输尿管上段结石的疗效比较

郝小强, 夏强, 顿文超

郝小强, 夏强, 顿文超. 输尿管软镜钬激光碎石术与输尿管硬镜碎石联合套石篮治疗输尿管上段结石的疗效比较[J]. 实用临床医药杂志, 2023, 27(2): 105-108. DOI: 10.7619/jcmp.20221649
引用本文: 郝小强, 夏强, 顿文超. 输尿管软镜钬激光碎石术与输尿管硬镜碎石联合套石篮治疗输尿管上段结石的疗效比较[J]. 实用临床医药杂志, 2023, 27(2): 105-108. DOI: 10.7619/jcmp.20221649
HAO Xiaoqiang, XIA Qiang, DUN Wenchao. Holmium laser lithotripsy by flexible ureteroscope versus rigid ureteroscopic lithotripsy combined with basket extraction of ureteral stone in treating upper ureteral calculus[J]. Journal of Clinical Medicine in Practice, 2023, 27(2): 105-108. DOI: 10.7619/jcmp.20221649
Citation: HAO Xiaoqiang, XIA Qiang, DUN Wenchao. Holmium laser lithotripsy by flexible ureteroscope versus rigid ureteroscopic lithotripsy combined with basket extraction of ureteral stone in treating upper ureteral calculus[J]. Journal of Clinical Medicine in Practice, 2023, 27(2): 105-108. DOI: 10.7619/jcmp.20221649

输尿管软镜钬激光碎石术与输尿管硬镜碎石联合套石篮治疗输尿管上段结石的疗效比较

详细信息
    通讯作者:

    夏强, E-mail: xq8558@126.com

  • 中图分类号: R693+.4;R615

Holmium laser lithotripsy by flexible ureteroscope versus rigid ureteroscopic lithotripsy combined with basket extraction of ureteral stone in treating upper ureteral calculus

  • 摘要:
    目的 

    比较输尿管软镜钬激光碎石术与输尿管硬镜钬激光碎石联合套石篮治疗输尿管上段结石的疗效及安全性。

    方法 

    回顾性分析145例经尿道输尿管镜治疗输尿管上段单发结石患者的临床资料。采用输尿管硬镜钬激光碎石联合套石篮治疗者74例为对照组,采用电子输尿管软镜下钬激光碎石治疗者71例为观察组。比较2组的手术时间、碎石成功率、结石逃逸率、输尿管损伤情况、术后2周残石率、术中出血及感染率。

    结果 

    对照组结石上移导致拦截失败10例,需留置输尿管支架管术后结合体外碎石及药物排石治疗; 观察组在Ⅰ期置入输尿管支架管扩张后Ⅱ期行钬激光碎石术,全部碎石成功。观察组结石逃逸率、碎石成功率高于对照组,平均手术时间长于对照组,差异有统计学意义(P < 0.05)。2组术中出血量、输尿管损伤率、术后感染率比较,差异无统计学意义(P>0.05)。

    结论 

    在钬激光治疗输尿管上段结石方面,应用输尿管软镜的疗效优于硬镜联合套石篮,但2种术式安全性相当。

    Abstract:
    Objective 

    To compare the efficacy and safety between holmium laser lithotripsy by flexible ureteroscope and rigid ureteroscopic lithotripsy combined with basket extraction of ureteral stone in treating upper ureteral calculus.

    Methods 

    The clinical materials of 145 patients with single upper ureteral calculus treated by transurethral ureteroscope were analyzed retrospectively. A total of 74 patients with rigid ureteroscopic lithotripsy and basket extraction of ureteral stone were named as control group, and 71 patients treated by holmium laser lithotripsy with flexible ureteroscope after purchasing electronic ureteroscope were named as observation group. The operation time, success rate of lithotripsy, escape rate of calculus, ureteral injury, residual stone rate at 2 weeks after operation, intraoperative bleeding and infection rate were compared between the two groups.

    Results 

    In the control group, 10 cases failed to intercept due to the upward movement of calculus, which required indwelling ureteral stents combined with extracorporeal lithotripsy and drug lithotripsy; holmium laser lithotripsy was successfully performed in the Ⅱ stage in the observation group after the ureteral stent was placed for expansion in the Ⅰ stage. The escape rate of calculus, success rate of lithotripsy and the average operation time in the observation group were significantly higher and longer than those in the control group (P < 0.05). There were no significant differences in the intraoperative bleeding, ureteral injury rate and postoperative infection rate between the two groups (P>0.05).

    Conclusion 

    In the treatment of upper ureteral calculus with holmium laser, the efficacy of flexible ureteroscope is better than that of rigid ureteroscope combined with basket extraction of ureteral stone, but the safety of the two operation methods is equivalent.

  • 表  1   2组一般资料比较[n(%)](x±s)

    组别 性别 年龄/岁 侧别 结石长径/cm
    对照组(n=74) 40(54.1) 34(45.9) 39.0±15.0 41(55.4) 33(44.6) 0.8±0.3
    观察组(n=71) 38(53.5) 33(46.5) 41.0±18.0 39(54.9) 32(45.1) 0.8±0.4
    下载: 导出CSV

    表  2   2组手术相关指标比较(x±s)[n(%)]

    组别 手术时间/min 一次性碎石成功 2周后结石清除 结石逃逸
    对照组(n=74) 36.0±12.0 65 (87.8) 72 (97.3) 10 (13.5)
    观察组(n=71) 45.0±18.0* 70 (98.6)* 69 (97.2) 21 (29.6)*
    与对照组比较, *P < 0.05。
    下载: 导出CSV

    表  3   2组并发症相关指标[n(%)] (x±s)

    组别 输尿管损伤 术中出血量/mL 术后感染
    对照组(n=74) 3(4.1) 118.0±5.0 1(1.4)
    观察组(n=71) 2(2.8) 123.0±3.0 1(1.4)
    下载: 导出CSV
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  • 收稿日期:  2022-05-24
  • 网络出版日期:  2023-02-17

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