输尿管镜逆推结石非原位钬激光碎石治疗输尿管中下段结石  

Ureteroscopic lithotripsy with reverse pushing method in the treatment of middle-lower ureteral calculi

作　　者：陈光彪 李腾成[2] 方友强[2] 蔡佳荣[2] 孙其鹏[2] 杨飞[2] 周祥福[2] 

机构地区：[1]常平人民医院泌尿外科,东莞523573 [2]中山大学附属第三医院泌尿外科,广州510630

出　　处：《中华腔镜泌尿外科杂志（电子版）》2015年第2期30-33,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：高校基本科研业务费青年教师培育项目(14YKPY25)

摘　　要：目的探讨输尿管镜直视下逆推结石非原位配合钬激光碎石治疗输尿管中下段结石的安全性和有效性。方法 60例输尿管中下段结石患者纳入本研究,其中30例采用逆推结石非原位输尿管镜钬激光碎石术(实验手术组),即直视下先将结石逆推至梗阻部位稍上方输尿管扩张处,再于非梗阻原位视野开阔处采用钬激光碎石;30例直视下找到结石后即行原位钬激光碎石术(传统手术组)。比较两组的总手术时间、碎石时间、一次性结石清除率以及手术并发症情况。结果 60例患者均全部成功碎石。实验组和传统组的总手术时间分别为(40±6)min和(55±8)min(t=-5.64,P<0.05),碎石时间分别为(12±5)min和(20±6)min(t=-9.36,P<0.05),一次结石取净率分别为100.0%(30/30)和96.7%(29/30)。传统手术组中输尿管发生穿孔1例,两组术中均无输尿管断裂、袖状撕脱和尿源性败血症等严重并发症发生。结论对于选择病例,输尿管镜下逆推结石非原位钬激光碎石术处理输尿管中下段结石安全有效,较原位碎石能减少碎石时间及手术并发症。Objective To evaluate the reverse pushing method during ureteroscopic holmium laser lithotripsy in the treatment of middle- inferior ureteral stones. Methods 60 patients with middle- lower ureteral stone were randomly selected in this study. Reverse pushing method group： 30 cases, and control group： 30 cases. The operative time, gravel time, full- time stone clearance rate and perioperative complications in these two groups were evaluated. Results All operations were successful with no case transferred to open surgery. Total operation time in study group and control group were （40±6） min vs （55± 8） min （t=-5.64, P〈0.05）. Time of stone removal were （12±5） min vs （20±6） min（t=-9.36, P〈0.05）. Stone clearance rate were 100.0% （30/30） vs 96.7% （29/30）. One case suffered from ureteral perforation in the control group. No ureter breakage, avulsion or septicemia occurred in two groups. Conclusion For selected cases, ureteroscopic holmium laser lithotripsy with reverse pushing method is one of safe and effective mangement for middle-lower ureteral calculi.

关 键 词：输尿管结石 输尿管镜技术 逆推法 治疗 

分 类 号：R699[医药卫生—泌尿科学]