新型改良旁置输尿管导管在输尿管镜钬激光碎石术中的应用研究  

Application of new modified paracalculous uteteral catheter in ureteroscopic holmium laser lithotripsy

作　　者：严友纪[1] 周家杰[1] 杨光华[1] 陈忠军 曾金敏[1] 廖义翔[1] 孙齐 杨涛[1] Yan Youji;Zhou Jiajie;Yang Guanghua;Chen Zhongjun;Zeng Jinmin;Liao Yixiang;Sun Qi;Yang Tao(Department of Urology,Jingzhou Central Hospital,Second Clinical College,Yangtze University,Jingzhou 434020,China)

机构地区：[1]长江大学第二临床医学院荆州市中心医院泌尿外科,434020

出　　处：《国际外科学杂志》2018年第9期600-602,共3页International Journal of Surgery

摘　　要：目的 探讨新型改良旁置输尿管导管在输尿管镜钬激光碎石术治疗输尿管中下段大结石的临床应用价值.方法 回顾性分析2014年1月-2017年1月荆州市中心医院收治的86例单侧输尿管中下段大结石患者的临床资料,按照随机数字表法分为两组：改良碎石组（43例术中镜体内留置输尿管导管,旁置于结石下方,通过导管注水行钬激光碎石）和直接碎石组（43例直接连接灌注泵注0.9％氯化钠溶液,行钬激光碎石）,两组患者均行输尿管镜钬激光碎石术.比较两组患者的平均手术时间、结石清除率、输尿管穿孔、中转开放,以及术后尿脓毒血症、肾周血肿、输尿管狭窄等并发症的情况.计量资料以均数±标准差（（x）±s）表示,组间比较采用t检验.结果 改良碎石组患者全部碎石成功,无输尿管穿孑孔、断裂、碎石通道丢失、中转开放及术后肾周血肿、尿脓毒血症等并发症发生.直接碎石组患者输尿管穿孔5例,通道丢失4例,中转开放6例,术后肾周血肿2例,尿脓毒血症1例.两组患者平均手术时间分别为（39.5±7.2）、（47.2±11.6） min（t=-4.975,P=0.001）,结石清除率分别为100.0％、91.1％.两组患者平均门诊随访1年,改良碎石组患者输尿管轻度狭窄3例,均未再次手术;直接碎石组患者术后输尿管轻度狭窄5例,严重狭窄2例再次手术.结论 输尿管镜钬激光碎石术治疗输尿管中下段大结石时,采用新型改良旁置输尿管导管方式注0.9％氯化钠溶液,安全有效,能缩短总手术时间,减少并发症的发生,有较高的临床推广价值.Objective To explore the clinical application value of new modified paracalculous ureteral catheter in ureteroscopic holmium laser lithotripsy for the treatment of large middle and lower ureteral stone. Methods From January 2014 to January 2017, 86 patients with unilateral middle and lower ureteral large stone were treated in Jingzhou Central Hospital. By adopted to random digital table, 86 patients were randomly separated into two groups, all of whom were treated with ureteroscopic holmium laser lithotripsy. Forty-three cases were underwent new modified laser lithotripsy with ureteral catheter inserted beneath the stone. Normal saline was injected continuously through the catheter during lithotripsy procedure （modified lithotripsy group ）. Forty-three cases were underwent direct ureteroscopic holmium laser lithotripsy （direct lithotripsy group）. The outcome data were compared between the two groups, such as the operation time, stone clearance rate, ureteral perforation, transit to open surgery, postoperative urinary sepsis, perirenal hematoma, ureterostenosis and other complications. Measurement data were expressed as （~ _＋ s）, and t test was used for comparison between groups. Results All the patients in the modified lithotripsy group were completed successfully without ureteral perforation, rupture, loss of lithotripsy channel, transit to open surgery, perirenal hematoma, and urinary sepsis and so on. In the direct lithotripsy group, there were 5 cases of ureteral perforation, 4 cases of lithotripsy channel loss, 6 cases of transit to open surgery, 2 cases of perirenal hematoma, 1 case of urinary sepsis. The operation time of the two groups was （ 39.5± 7.2） min and （47.2 ± 11.6） min, respectively, t = -4. 975 ,P =0.001. Stone clearance rate was 100%, 91.1%. The patients in both groups received an average of 1 year out-patient follow- up. There were 3 cases of mild ureterostenosis in the modified lithotripsy group, which were not re-operated. In the direct lithotripsy group, there were 5

关 键 词：输尿管结石 输尿管镜 导尿管插入术 

分 类 号：R699.4[医药卫生—泌尿科学]