输尿管镜碎石与体外冲击波碎石治疗输尿管结石的临床疗效比较  

Comparison between Ureteroscopy with Holmium:YAG Laser Lithotripsy and Extracorporeal Shocl-wave Lithotripsy in Treating Ureteral Calculi

作　　者：吴建军[1] 

机构地区：[1]成都市第六人民医院泌尿外科,成都市610051

出　　处：《中国激光医学杂志》2014年第6期323-326,共4页Chinese Journal of Laser Medicine & Surgery

摘　　要：目的比较输尿管镜碎石(Transurethral Ureteroscopic Lithotripsy,URL)与体外冲击波碎石术(Extracorporeal Shock-Wave Lithotripsy,ESWL)治疗输尿管结石的临床疗效。方法输尿管结石患者130例,根据随机数字表分为两组:体外冲击波碎石(Extracorporeal shock-wave lithotripsy,ESWL)组,患者63例;输尿管镜碎石(Transurethral ureteroscopic lithotripsy,URL)组,患者67例。比较两组患者不同部位、直径结石的清除率和术后并发症。结果两组患者均无肾脏和输尿管周围血肿,输尿管穿孔或撕脱等并发症发生。URL组结石总清除率优于ESWL组,差异具有显著意义(P<0.05);两组患者的结石直径<1 cm的结石清除率比较,差异无显著意义(P>0.05)。ESWL组在输尿管上段结石清除率优于URL组。URL组输尿管中下段结石、直径≥1 cm结石清除率明显优于ESWL组。ESWL组上段结石清除率优于中下段;直径<1 cm结石清除率优于≥1 cm者。URL组中下段结石清除率优于上段,不同直径结石清除率差异无显著意义。结论 ESWL和URL在治疗输尿管结石时各有优势。ESWL可作为直径<1.0 cm的输尿管上段结石的首选治疗;而URL则在直径≥1 cm的输尿管中、下段结石更有优势,可作为首选治疗。Objective To evaluate the safety and efficacy of ureteroscopy combined with Ho ： YAG laser and extracorporeal shocl-wave lithotripsy （ESWL） in treating patients with ureteral calculi. To compare the therapeutic effects of these two methods. Methods A randomized and controlled trial was adopted. The clinical data of 130 patients with ureteral calculi were retrospectively re-viewed, including 63 patients treated with ESWL and 67 patients with URL and Ho ： YAG laser. The postoperative perioperative indica- tors of the two groups were compared. Results The patients in both groups rehabilitated smoothly, and no complication was observed. Neither hematoma nor ureter perfora- tion occurred during or after the operation. There was remarkable difference in stone clearance rate between the two groups （P 〈 0. 05）. For patients with stones ≥ 1 cm and in middle and lower ureteral, URL was more effective （P 〈 0. 01 ）. As to patients with stones 〈 1 cm and in upper ureteral, ESWL is more effective （ P 〈 0.05 ）. The therapeutic effects of these two methods are quite alike when the diameter of stones was less than 1 cm. Conclusions While ESWL being highly recommended to patients with stones 〈 1 cm in upper ureteral, URL with Ho ： YAG laser is the best choice for patients with stones ≥ 1 cm and in middle and lower ureteral.

关 键 词：激光 输尿管结石 输尿管镜钬激光碎石术 体外冲击波碎石术 

分 类 号：R693.4[医药卫生—泌尿科学] R454.2[医药卫生—外科学]