改良输尿管镜钬激光碎石术治疗输尿管中、下段结石的有效性和安全性分析  

Analysis of the clinical efficacy and safety of modified ureteroscopic holmium laser lithotripsy in the treatment of middle and lower ureteral stones

作　　者：张江兵 曹沪春 周岩[1] 章良庆 王伟 王跃[1] ZHANG Jiang-bing;CAO Hu-chun;ZHOU Yan;ZHANG Liang-qing;WANG Wei;WANG Yue(Department of Urinary Surgery,Wuhu First People′s Hospital,Wuhu Anhui 241000,China)

机构地区：[1]安徽省芜湖市第一人民医院泌尿外科,241000

出　　处：《蚌埠医学院学报》2021年第3期372-375,共4页Journal of Bengbu Medical College

摘　　要：目的:探讨改良输尿管镜狄激光碎石术治疗输尿管中、下段结石的有效性和安全性。方法:选择119例输尿管中、下段结石病人临床资料,其中60例采用常规输尿管镜钬激光碎石术(常规组),59例采取改良的输尿管镜钬激光碎石术(改良组),观察2组一次进镜成功率、进镜时间、手术总时间、结石清除率及并发症发生情况。结果:常规组与改良组一次进镜成功率分别是83.3%和96.6%,2组差异具有统计学意义(P<0.05);改良组进镜时间较常规组缩短(P<0.05),总手术时间明显降低(P<0.01);常规组与改良组术后4周的结石清除率分别为81.7%和96.6%,2组差异有统计学意义(P<0.01);2组术后并发症总发生率差异无统计学意义(P>0.05)。结论:改良输尿管镜钬激光碎石术通过调整进镜方式、控制碎石的能量与频率、注意进水压力及速度能有效防止结石上移,利于结石清除,减少手术总时间,手术并发症发生率未见明显上升,进一步提升手术效果及安全性,值得临床推广。Objective:To explore the clinical efficacy and safety of modified ureteroscopic holmium laser lithotripsy in the treatment of middle and lower ureteral stones.Methods:The clinical data of 119 patients with middle and lower ureteral stones were retrospectively analyzed.Sixty cases were treated with conventional ureteroscopic holmium laser lithotripsy(conventional group),and 59 cases were treated with modified ureteroscopic holmium laser lithotripsy(modified group).The success rate of one-time endoscopic entry,endoscopic entry time,total operation time,clearance rate of stone and complications were compared between two groups.Results:The success rates of one-time endoscopic entry in the conventional group and modified group were 83.3%and 96.6%,respectively,and the difference of which was statistically significant(P<0.05).The endoscopic entry time in modified group was shorter than that in conventional group(P<0.05),and the total operation time in modified group was significantly lower than that in conventional group(P<0.01).The stone clearance rate in the conventional group and modified group after 4 weeks of operation were 81.7%and 96.6%,respectively,and the difference of which was statistically significant(P<0.01).The incidence rate of postoperative complications was not statistically significant between two groups(P>0.05).Conclusions:The modified ureteroscopic holmium laser lithotripsy can effectively prevent the upward movement of stone through adjusting the way of endoscopic entry,controlling the energy and frequency of gravel and adjusting the inlet pressure and speed to facilitate the removal of stone,reduce the total operation time,not improve incidence rate of complications,and further improve the operation effect and safety,which is worthy of promotion in clinic.

关 键 词：输尿管结石 输尿管镜 钬激光 

分 类 号：R693.4[医药卫生—泌尿科学]