经输尿管镜钬激光与气压弹道碎石术治疗输尿管上段结石的效果对比(1)
[摘要]目的 比较输尿管镜下气压弹道碎石术与钬激光碎石术治疗输尿管上段结石的临床效果。方法 选取2013年7月～2017年7月在我院确诊收治的输尿管上段结石患者506例，随机分成两组，钬激光组256例和气压弹道组250例，比较两组患者碎石成功率、排净率、并发症、手术时间及住院时间等。结果 钬激光组碎石成功率为96.88%，高于气压弹道组的86.40%，差异有统计学意义(P<0.05)；术后4周复查，钬激光组结石排净率为96.88%，气压弹道组为83.60%，差异有统计学意义(P<0.05)；钬激光组并发症发生率为10.16%，低于气压弹道组的21.60%，差异有统计学意义(P<0.05)；而手术时间、住院时间等两组比较差异无统计学意义(P>0.05)。结论 钬激光碎石术的有效率和安全性优于气压弹道碎石术。钬激光碎石是治疗输尿管上段结石的一种安全、高效的方法，值得临床推广。
[关键词]钬激光；气压弹道；碎石术；输尿管结石；输尿管镜
[中图分类号] R693.4 [文献标识码] A [文章编号] 1674-4721(2018)2(a)-0073-04
[Abstract]Objective To compare the efficacy of Holmium：YAG laser and pneumatic lithotripsy in the treatment of upper-ureteral calculi.Methods From July 2013 to July 2017，506 patients with upper-ureteral calculi were randomly divided into two groups，256 cases in holmium laser lithotripsy group and 250 cases in pneumatic lithotripsy group.The successful rate，stone free rate，complications，operative time and hospital stays were compared between the two groups.Results The effective rate of holmium lithotripsy group was 96.88%，which was higher than 86.40% of the pneumatic lithotripsy group，and the difference was statistically significant(P<0.05).After 4 weeks of postoperative review，the stone free rate of lithotripsy was 96.88%，and the pressure ballistic lithotripsy was 83.60%，and the difference was statistically significant(P<0.05).The complication rate of holmium lithotripsy group was 10.16%，lesser than 21.60% of the pressure ballistic-lithotripsy group，and the difference was statistically significant(P<0.05).There was no significant difference between operation time，hospital stays.Conclusion The efficiency and safety of holmium laser lithotripsy are superior to pneumatic lithotripsy.Holmium lithotripsy is a safe and effective method for treating ureteral calculi，and worthy of being widely applied in clinic.
[Key words]Holmium Laser；Pneumatic；Lithotripsy；Ureteral calculi；Ureteroscope
輸尿管结石是泌尿系统结石中常见的结石类型，发病率约占上尿路结石的65%，而90%以上的输尿管结石是在肾内形成下移至输尿管的[1]，也就是说原发性的输尿管结石比较少见。目前对输尿管结石治疗主要采用输尿管镜下碎石取石术，碎石方式主要集中于气压弹道碎石及钬激光碎石。本研究对输尿管镜下气压弹道碎石术与钬激光碎石术在输尿管上段结石治疗效果进行比较，现报道如下。
1资料与方法
1.1一般资料
回顾2013年7月～2017年7月我院确诊收治的506例输尿管上段结石患者。所有患者均经超声、腹部平片(KUB)、静脉肾盂造影、CT等确诊，经患者同意及我院医学伦理委员会审核批准。随机分为两组。钬激光组256例，其中男135例，女121例；年龄27～76岁，平均42岁；结石横径0.9～2.0 cm；病程0.5 d～5个月，均为输尿管上段结石。气压弹道组250例，其中男131例，女119例；年龄28～76岁，平均43.5岁；结石横径0.9～2.0 cm；病程0.5 d～5个月，均为输尿管上段结石。两组患者的性别、年龄、病程、结石横径以及结石部位等比较，差异无统计学意义(P>0.05)，具有可比性。入选标准：患者无输尿管畸形或扭曲；无肾功不全；确诊的单侧输尿管上段结石；无合并同侧肾结石；合并感染者经抗感染治疗后，感染得到控制；经患者本人及家属同意；无手术及麻醉禁忌证。排除标准：结石直径<0.9 cm或>2.0 cm；合并有同侧肾结石；中重度肾功能受损或重度肾积水；输尿管开口狭窄无法进镜者；合并感染未能控制者；有手术禁忌证者。, 百拇医药(杨云杰 徐勋 刘芑 冯权尧)
[关键词]钬激光；气压弹道；碎石术；输尿管结石；输尿管镜
[中图分类号] R693.4 [文献标识码] A [文章编号] 1674-4721(2018)2(a)-0073-04
[Abstract]Objective To compare the efficacy of Holmium：YAG laser and pneumatic lithotripsy in the treatment of upper-ureteral calculi.Methods From July 2013 to July 2017，506 patients with upper-ureteral calculi were randomly divided into two groups，256 cases in holmium laser lithotripsy group and 250 cases in pneumatic lithotripsy group.The successful rate，stone free rate，complications，operative time and hospital stays were compared between the two groups.Results The effective rate of holmium lithotripsy group was 96.88%，which was higher than 86.40% of the pneumatic lithotripsy group，and the difference was statistically significant(P<0.05).After 4 weeks of postoperative review，the stone free rate of lithotripsy was 96.88%，and the pressure ballistic lithotripsy was 83.60%，and the difference was statistically significant(P<0.05).The complication rate of holmium lithotripsy group was 10.16%，lesser than 21.60% of the pressure ballistic-lithotripsy group，and the difference was statistically significant(P<0.05).There was no significant difference between operation time，hospital stays.Conclusion The efficiency and safety of holmium laser lithotripsy are superior to pneumatic lithotripsy.Holmium lithotripsy is a safe and effective method for treating ureteral calculi，and worthy of being widely applied in clinic.
[Key words]Holmium Laser；Pneumatic；Lithotripsy；Ureteral calculi；Ureteroscope
輸尿管结石是泌尿系统结石中常见的结石类型，发病率约占上尿路结石的65%，而90%以上的输尿管结石是在肾内形成下移至输尿管的[1]，也就是说原发性的输尿管结石比较少见。目前对输尿管结石治疗主要采用输尿管镜下碎石取石术，碎石方式主要集中于气压弹道碎石及钬激光碎石。本研究对输尿管镜下气压弹道碎石术与钬激光碎石术在输尿管上段结石治疗效果进行比较，现报道如下。
1资料与方法
1.1一般资料
回顾2013年7月～2017年7月我院确诊收治的506例输尿管上段结石患者。所有患者均经超声、腹部平片(KUB)、静脉肾盂造影、CT等确诊，经患者同意及我院医学伦理委员会审核批准。随机分为两组。钬激光组256例，其中男135例，女121例；年龄27～76岁，平均42岁；结石横径0.9～2.0 cm；病程0.5 d～5个月，均为输尿管上段结石。气压弹道组250例，其中男131例，女119例；年龄28～76岁，平均43.5岁；结石横径0.9～2.0 cm；病程0.5 d～5个月，均为输尿管上段结石。两组患者的性别、年龄、病程、结石横径以及结石部位等比较，差异无统计学意义(P>0.05)，具有可比性。入选标准：患者无输尿管畸形或扭曲；无肾功不全；确诊的单侧输尿管上段结石；无合并同侧肾结石；合并感染者经抗感染治疗后，感染得到控制；经患者本人及家属同意；无手术及麻醉禁忌证。排除标准：结石直径<0.9 cm或>2.0 cm；合并有同侧肾结石；中重度肾功能受损或重度肾积水；输尿管开口狭窄无法进镜者；合并感染未能控制者；有手术禁忌证者。, 百拇医药(杨云杰 徐勋 刘芑 冯权尧)