输尿管结石术前综合评价对碎石方式选择的作用  

The role of ureteral stone preoperative evaluation for the selection of lithotrity

作　　者：郑贯忠 王元天[2] 曹志彬 张士文 杨伟忠 袁铮豪 何立峰 黄翼然[2] 

机构地区：[1]上海市嘉定区中心医院泌尿外科,上海201800 [2]上海交通大学附属仁济医院泌尿外科

出　　处：《临床泌尿外科杂志》2008年第12期905-907,共3页Journal of Clinical Urology

基　　金：上海市嘉定区科委科研课题资助(No:2007;JKK.02219)

摘　　要：目的:探讨输尿管结石术前的综合评价在确定和指导碎石方式的选择、提高碎石效率方面的作用。方法:将645例患者分为随机组(178例)和综合评价组(467例)。术前进行综合评价,按结石部位分为输尿管上段、中段和下段,按结石大小分为≤7mm、8～10mm、>10mm,按结石密度分为高密度、中密度、疏松结石,按结石数量分为单发、多发。在碎石方法的选择上遵循下段、≤7mm、疏松结石和单发结石优先考虑采用气压弹道碎石;中密度、中段、8～10mm、多发结石优先考虑采用双频激光碎石;上段、>10mm、高密度、多发结石优先考虑采用钬激光碎石的原则。结果:随机组采用气压弹道碎石52例,双频激光碎石85例,钬激光碎石41例。综合评价组采用气压弹道碎石107例,双频激光碎石148例,钬激光碎石212例。两组碎石成功率分别为88.2%和93%,结石排净率分别为84%和89.3%。患者平均住院天数分别为7天和5天。平均住院费用综合评价组比随机组下降5%～8%。结论:术前对患者进行综合评价,并指导选择合理的碎石方式,可以使碎石成功率、结石排净率和住院时间均达到最佳,使住院费用明显降低。Objective：To diseusse the role of ureteral stone preoperative evaluation for determining, guiding the selection of lithotrity, and improving the efficiency of lithotrity. Methods： 645 cases of ureteral calculi（425 males and 220 females; aged 19-71 years ） were divided into two groups： random group（n=178） and multi evaluation Group（n=467）. The factors be evaluated include the stone location （in the proximal part of the ureter, in the middle part or in the distal part）, the diameter of the stones（≤7 ram, 8--10 mm, 〉10 mm）, the density （high density, middle density and low density）and the amount of stones（one stone and more than one）. The general rule is the stone in the distal part of the ureter and ≤7 mm in the diameter underwent pneumatic lithotripsy; the more than one stone in the middle part, middle density and 8 10 ram in the diameter underwent frequency-doubled double pulse laser; the more than one stone in the proximal part, high density and 〉10 mm treated via uretero scope with Ho： YAG laser. Results： Random group： pneumatic lithotripsy 52 cases, frequency- doubled double- pulse laser 85 cases, holmium laser 41 eases; multi evaluation Group： pneumatic lithotripsy 107 cases, frequency doubled double-pulse laser 148 cases, holmium laser 212 cases. The success rate （stone fragmentation rate） was 88.2% and 93 %. The stone -free rate was 84.0% and 89.3%. Hospital stay was 7 and 5 d. The average cost in hospital for Multi evaluation Group is 5-8 percent down than Random group＇s. Conclusions： Pre-operation multi factor evaluation can give a good guidance for the choice of lithotripsy, and can raise up the success rate, and shorten the hospital day. It also can decrease the cost in hospital.

关 键 词：输尿管结石 综合评价 气压弹道碎石 双频激光碎石 钬激光碎石 

分 类 号：R693[医药卫生—泌尿科学]