双导丝引导下输尿管硬镜联合输尿管导引鞘治疗嵌顿性输尿管结石合并息肉的疗效分析  

Treatment of impacted ureteral calculi with polypus using semirigid ureteroscopy with two guidewires and ureteral access sheath

作　　者：金丹 方立 王正义 谢国海[1] 胡嘉盛[1] 程跃[1] JIN Dan;FANG Li;WANG Zhengyi;XIE Guohai;HU Jiasheng;CHENG Yue(Department of Urology,Center of Urology and Nephropathy,Ningbo First Hospital of Zhejiang Province,Ningbo 315010;School of Medicine,Ningbo University,Ningbo 315211,China)

机构地区：[1]宁波市第一医院泌尿肾病中心泌尿外科,浙江宁波315010 [2]宁波大学医学院,浙江宁波315211

出　　处：《现代泌尿外科杂志》2022年第4期295-299,共5页Journal of Modern Urology

基　　金：浙江省医药卫生科技面上项目(No.2019326541)。

摘　　要：目的分析双导丝引导下使用输尿管硬镜联合输尿管导引鞘治疗嵌顿性输尿管结石合并息肉的临床疗效。方法回顾性分析2016年4月-2020年8月浙江省宁波市第一医院使用输尿管硬镜治疗嵌顿性结石患者82例的临床资料,其中38例采用双导丝引导下输尿管硬镜联合输尿管导引鞘方法治疗(双导丝组),44例予单导丝输尿管硬镜治疗(单导丝组)。对围术期相关指标、结石清除情况和术后并发症发生情况进行比较分析。结果双导丝组术后血红蛋白下降值[(0.73±1.42)g/dL]显著低于单导丝组[(9.86±8.50)g/dL],双导丝组术后住院时间[(2.79±0.53)d]较单导丝组[(3.27±0.62)d]更短,双导丝组术后第1天清石率(94.7%)显著高于单导丝组(77.3%),差异均具有统计学意义(P<0.05)。两组的手术时间、术后肌酐下降值、拔管后1个月清石率、术后发热及输尿管狭窄发生率差异无统计学意义(P>0.05)。结论应用双导丝引导输尿管硬镜联合输尿管导引鞘的方法治疗合并息肉的输尿管嵌顿性结石安全、有效。Objective To observe the clinical outcomes of semirigid ureteroscopy with two guidewires and ureteral access sheath in the treatment of impacted ureteral calculi with polypus.Methods Clinical data of 82 patients with impacted ureteral calculi treated with semirigid ureteroscopy during Apr.2016 and Aug.2020 were retrospectively analyzed,including 38 patients treated with semirigid ureteroscopy with two guidewires and ureteral access sheath(double guidewire group)and 44 patients treated with semirigid ureteroscopy alone(single guidewire group).The perioperative status,stone clearance and complications were compared.Results The postoperative hemoglobin reduction in the double guidewire group[(0.73±1.42)g/dL]was sig⁃nificantly lower than that in the single guidewire group[(9.86±8.50)g/dL].Postoperative hospital stay was shorter in the double guidewire group[(2.79±0.53)d]than in the single guidewire group[(3.27±0.62)d].The stone clearance rate in the double guidewire group(94.7%)was significantly higher than that in the single guidewire group(77.3%)(P<0.05).There were no differences in operation time,postoperative creatinine decrease,stone clearance rate one month after extubation,incidence of fever and ureteral stricture between the two groups(P>0.05).Conclusion Semirigid ureteroscopy with two guidewires and ureteral access sheath is safe and effective in treating impacted ureteral calculi with polypus.

关 键 词：嵌顿性输尿管结石 双导丝 输尿管导引鞘 输尿管镜 输尿管息肉 清石率 输尿管狭窄 

分 类 号：R693.4[医药卫生—泌尿科学]