三种不同输尿管镜手术方式处理输尿管上段结石的疗效分析  

Analysis of the efficacy of three different methods of ureteroscopic surgery in the treatment of upper ureteral calculi

作　　者：张履文 宋彦[1] 费翔[1] Zhang Lyuwen;Song Yan;Fei Xiang(Department of Urology Surgery,Shengjing Hospital affiliated to China Medical University,Shenyang 110000,China)

机构地区：[1]中国医科大学附属盛京医院泌尿外科,沈阳110000

出　　处：《中国综合临床》2021年第3期275-279,共5页Clinical Medicine of China

摘　　要：目的分析新型负压吸引输尿管镜、传统输尿管硬镜及软镜碎石术治疗输尿管上段结石的临床疗效。方法本研究纳入了2018年1月至2020年1月符合条件的在中国医科大学附属盛京医院接受治疗的160例明确诊断的输尿管上段嵌顿结石患者,对其临床资料进行回顾性分析。其中输尿管硬镜组50例,输尿管软镜组54例,新型负压组合式输尿管镜组56例。观察比较3组的手术时间、住院时间、净石率、术后并发症发生率的差异。并按照结石最大直径是否>1.5 cm进行亚组分析,进一步比较分析3组手术方式的疗效。结果160例手术均成功完成,无中途转为开放手术。部分患者复查CT术后3~5 d新型负压吸引输尿管镜组[20例,(18例净石)]较输尿管软镜组[21例(3例净石)]、输尿管硬镜组[18例(10例净石)]具有优势,χ^(2)=8.490,P<0.001]。术后第1个月净石率同样具有优势[(96.4%(54/56)、77.7%(42/54)、74.0%(37/50),χ^(2)=5.480,P=0.010)]。通过结石亚组分析得出,当结石直径增加时(>1.5 cm),新型负压吸引输尿管镜组的净石率[91.6%(22/24)]较输尿管软镜组[62.5%(15/24)]、输尿管硬镜组[50.0(8/16)]优势更加明显(χ^(2)=6.480,P=0.001)。结论新型负压吸引输尿管镜碎石相对于传统输尿管镜碎石具有较高的初始和整体净石率,且安全系数更高。对于结石直径>1.5 cm的患者,新型负压吸引输尿管镜碎石更具有优势。Objective To introduce the experience and clinical efficacy of a new type of negative pressure suction ureteroscope in the treatment of upper ureteral calculi,and compare it with traditional rigid ureteroscope and flexible ureteroscope lithotripsy.Methods From January 2018 to January 2020,160 patients with upper ureteral incarcerated calculi who were treated in Shengjing Hospital Affiliated to China Medical University were included in this study,and their clinical data were retrospectively analyzed.There were 50 cases in the rigid ureteroscope group,54 cases in the flexible ureteroscope group and 56 cases in the new negative pressure combined ureteroscope group.The differences of operation time,hospital stay,stone free rate and postoperative complications were observed and compared among the three groups.According to whether the maximum diameter of the stone is more than 1.5 cm,the subgroups were analyzed to further compare the curative effect of the three groups.Results All the 160 operations were completed successfully and none of them were converted to open surgery.The stone free rate of the new negative pressure suction ureteroscope Group(90.0%(18/20))was higher than that of the flexible ureteroscope Group(61.9%(13/21))and the rigid ureteroscope Group(55.6%(10/18)),χ^(2)=8.49,P<0.001).The stone free rate in the first month after operation was also superior(96.4%(54/56),77.7%(42/54),74.0%(37/50),χ^(2)=5.48,P=0.01).The stone subgroup analysis showed that when the stone diameter increased(>1.5 cm),the net stone rate of the new negative pressure suction ureteroscope Group[91.6%(22/24)]was better than that of the flexible ureteroscope Group(62.5%(15/24))and the rigid ureteroscope Group(50.0(8/16))(χ^(2)=6.480,P=0.001).Conclusion Compared with the traditional ureteroscopic lithotripsy,the new negative pressure suction ureteroscopic lithotripsy has higher initial and overall stone free rate,and higher safety factor.For the patients with stone diameter>1.5 cm,the new negative pressure suction ureteroscope lithotri

关 键 词：输尿管上段结石 输尿管镜碎石术 负压吸引 疗效 

分 类 号：R699.4[医药卫生—泌尿科学]