输尿管管路封堵器在输尿管镜钬激光碎石术中的安全性和有效性分析  

Effectiveness and safety of ureteral tract occlusive device in the management of ureteroscopy combined holmium laser lithotripsy

作　　者：裴利军[1] 粟宏伟[1] 邓青富[1] 朱永生[1] 姜睿[1] 杨海帆[1] 

机构地区：[1]泸州医学院附属医院泌尿外科,四川泸州646000

出　　处：《泸州医学院学报》2014年第2期157-160,共4页Journal of Luzhou Medical College

摘　　要：目的:评价输尿管管路封堵器在输尿管镜钬激光碎石术中的安全性和有效性。方法:回顾性分析我院泌尿外科2010年3月至2012年8月间具有完整病例资料的输尿管结石患者309例,其中输尿管镜治疗组178例,输尿管镜联合管路封堵器治疗组131例,比较各组平均手术时间、平均住院日、结石清除率、输尿管损伤、术后发热、结石残留等并发症发生率的差异。结果:输尿管镜治疗组平均手术时间和总的结石清除率与输尿管镜联合封堵器治疗组无统计学差异,但是对于输尿管中上段结石,输尿管镜治疗组平均手术时间为45.3±13.4 min,结石清除率为85.5%,输尿管镜联合封堵器组平均手术时间为34.3±16.9 min,结石清除率为91.7%(χ2=9.870,P<0.05)。输尿管镜治疗组共发生输尿管损伤12例(6.7%),输尿管镜联合封堵器组为9例(6.8%),无统计学差异(χ2=4.310,P>0.05)。输尿管镜治疗组共发生结石上移至肾脏13例(7.3%),其中9例(11.8%)为输尿管中上段结石,输尿管镜联合封堵器治疗组共发生2例(4.2%),均为中上段结石(χ2=8.943,P<0.05)。输尿管镜治疗组20例(11.2%)术后出现不同程度发热,输尿管镜联合封堵器治疗组为5例(3.8%),具有统计学差异(χ2=8.778,P<0.05)。输尿管镜治疗组和输尿管镜联合封堵器治疗组平均住院日分别为1.9±1.1 d和1.8±1.2 d(P>0.05)。结论:输尿管镜钬激光碎石术中联合应用输尿管管路封堵器不增加输尿管损伤风险,可有效提高输尿管中上段结石清除率,缩短手术时间,降低术后发热、结石残留等并发症。Objective： To evaluate the effectiveness and safety of ureteral tract occlusive device in the management of ureteroscopy combined holmium laser lithotripsy. Methods： 309 cases of ureteral calculi from March 2010 to August 2012 with integral history were divided into two groups. 179 cases were treated by ureteroscopy（control group）, and 131 cases were treated by ureteroscopy combined tract occlusive device（TOD group）. The mean operation time, hospital stay, stone clearance rate and complications such as ureteral injury,postoperative fever and residual stones in the two groups were retrospectively analysed. Results： There were no significant difference in the mean operation time and stone clearance rate between the two groups. But for the middle and upper ureteral calculi, the mean operation time in TOD group（34.3 ± 16.9 min） was significantly decreased than in control group（45.3 ± 13.4 min,P 0.05）,and the stone clearance rate in TOD group（91.7%）was significantly increased than in control group（85.5%,χ2= 9.870,P〈 0.05）.The ureteral injury rate in control group（12,6.7%） was similar with that of TOD group（9,6.8%,χ2= 4.310,P〉 0.05）. The intrarenal stone migration occurred in TOD group（2, 4.2%） was significantly decreased than in control group（13, 7.3%,χ2= 8.943,P〈 0.05）.The postoperative fever in TOD group（5, 3.8%） were significantly decreased than in control group（20,11.2%,χ2= 8.778,P〈 0.05）. The mean hospital stay was similar between the control group（1.9 ± 1.1d） and TOD group（1.8 ± 1.2d）. Conclusion： The application of ureteral tract occlusive device in the control combined holmium laser lithotripsy does not increase the risks of ureteral injury, but can effectively increase the stone clearance rate for middle and upper ureteral stones, and decrease the operation time,postoperative fever and residual stones.

关 键 词：输尿管管路封堵器 输尿管镜 钬激光 输尿管结石 

分 类 号：R693.4[医药卫生—泌尿科学]