改良输尿管镜钬激光碎石术治疗输尿管嵌顿性结石的疗效研究  

Therapeutic effect of modified ureteroscopy with holmium laser lithotripsy for ureteral incarcerated stones

作　　者：冯战启[1] 景治安[1] 刘彦军[1] Feng Zhanqi;Jing Zhian;Liu Yanjun(Department of Urology,Zhengzhou First People's Hospital,Zhengzhou 450004,China)

机构地区：[1]郑州市第一人民医院泌尿外科,郑州450004

出　　处：《国际泌尿系统杂志》2022年第3期430-433,共4页International Journal of Urology and Nephrology

基　　金：河南省卫健委委部联合共建项目(2018020731)。

摘　　要：目的探讨改良输尿管镜钬激光碎石术治疗输尿管嵌顿性结石的手术技巧及临床疗效。方法回顾分析2015年1月至2019年12月在本院采用输尿管镜钬激光碎石术治疗的112例输尿管嵌顿性结石患者的临床资料,根据是否应用改良输尿管镜钬激光碎石术分为早期手术组(未采用自制进水通道,46例)和后期手术组(采用自制进水通道,66例),术后留置1根6F的D-J管或1~2根5F的D-J管,1~3个月后拔管。比较两组手术时间、结石清除率、感染发生率及输尿管狭窄发生率等。结果早期手术组的平均手术时间为51 min,术后输尿管狭窄发生率为19.57%(9/46),感染发生率为21.74%(10/46),结石清除率为76.09%(35/46),手术成功率为73.91(34/46);后期手术组的平均手术时间为32 min,术后输尿管狭窄发生率为3.03%(2/66),感染发生率为4.55%(3/66),结石清除率为95.45%(63/66),手术成功率为95.45%(63/66),两组的上述指标比较,差异均有统计学意义(均P<0.05)。结论改良输尿管镜钬激光碎石术治疗输尿管嵌顿性结石安全、有效,输尿管镜下自制进水通道制作简单,操作便利,同时配合术中对各种细节把控,可有效缩短手术时间,提高结石清除率,减少术后输尿管狭窄及尿路感染的发生率。Objective To explore the surgical technique and clinical effect of holmium laser lithotripsy under modified ureteroscopy for ureteral incarcerated stones.Methods Retrospective analysis of clinical data of 112 cases of ureteral incarcerated stones were treated with ureter holmium laser in our hospital from January 2015 to December 2019 was performed,according to whether the application of modified ureteroscopy holmium laser lithotripsy,all patients were divided into the early surgery group(not using homemade water channel,n=46)and late surgery group(use homemade water passage,n=66).One D-J tube of 6F or one or two D-J tubes of 5F was indwelled postoperatively,and extubation was performed 1-3 months later.Operation time,operative stone clearance rate,incidence of infection and incidence of ureteral stricture were compared between the two groups.Results The average operation time in the early operation group was 51 minutes,the incidence of postoperative ureteral stenosis was 19.57%(9/46).The incidence of infection was 21.74%(10/46),the calculi clearance rate was 76.09%(35/46),and success rate of operation was 73.91%(34/46),the average operation time in the late surgery group was 32 minutes,and the incidence of postoperative ureteral stenosis was 3.03%(2/66),the infection rate was 4.55%(3/66),and the calculi clearance rate was 95.45%(63/66),and success rate of operation was 95.45%(63/66),there was statistically significant difference in surgical indexes between the two groups(all P<0.05).Conclusions Improved ureteroscope holmium laser lithotripsy for ureteral incarcerated stones is safe and effective.The self-made water inlet channel under ureteroscope is simple to make and convenient to operate.At the same time,it controls various details during the operation,which can shorten the operation time and improve surgical stone removal rate to reduce the incidence of postoperative ureteral stenosis and urinary tract infections.

关 键 词：输尿管结石 输尿管镜检查 激光 固体 碎石术 

分 类 号：R699.4[医药卫生—泌尿科学]