钬激光联合封堵导管、取石网篮“三步法”治疗输尿管中上段结石  

Holmium Laser Lithotripsy With Using a Blocking Catheter and a Mesh Basket“Three-step Method”in the Treatment of Upper and Middle Ureteral Calculi

作　　者：刘吉平 张国胜 单小辉 刘啸雨 Liu Jiping;Zhang Guosheng;Shan Xiaohui(Department of Urology,Funing People’s Hospital of Qinhuangdao,Qinhuangdao 066300,China)

机构地区：[1]河北省秦皇岛市抚宁区人民医院泌尿外科,秦皇岛066300

出　　处：《中国微创外科杂志》2022年第12期958-961,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨封堵导管拦截、钬激光碎石、取石网篮取石“三步法”治疗输尿管中上段结石的应用价值。方法回顾性分析2019年1月~2021年12月134例输尿管中上段结石手术资料,根据患者意愿,其中68例采取“三步法”(观察组),66例传统输尿管镜钬激光碎石(对照组)。比较2组手术时间、结石逃逸率、清石率、输尿管损伤率、术后发热率和术后输尿管狭窄率。结果观察组手术时间[(21.8±3.4)min]显著短于对照组[(25.7±6.8)min,t=-4.192,P=0.000],结石逃逸率[7.4%(5/68)]显著低于对照组[27.3%(18/66),χ^(2)=9.347,P=0.002],清石率[97.1%(66/68)]显著高于对照组[75.8%(50/66),χ^(2)=13.069,P=0.000]。观察组术后发热率[7.4%(5/68)vs.19.7%(13/66),χ^(2)=4.389,P=0.036]、输尿管损伤率[4.4%(3/68)vs.16.7%(11/66),χ^(2)=5.376,P=0.020]、输尿管狭窄率[2.9%(2/68)vs.13.6%(9/66),χ^(2)=5.084,P=0.024]均显著低于对照组。结论封堵导管拦截、钬激光碎石、取石网篮取石“三步法”治疗输尿管中上段结石可以降低结石飘移到肾盂风险,减少术中更改输尿管软镜碎石可能,具有手术时间短、安全有效、清石率高等优点。Objective To investigate the value of holmium laser lithotripsy in combination with a blocking catheter and a mesh basket which named“three-step method”in the treatment of upper and middle ureteral stones.Methods A total of 134 patients with upper and middle ureteral stones treated in our hospital from January 2019 to December 2021 were selected.There were 68 patients who underwent“three-step method”(observation group)and 66 patients treated with holmium laser only(control group).The two groups were compared in terms of operative time,stone escape rate,stone clearance rate,ureteral injury rate,postoperative fever rate,and incidence of postoperative ureteral stricture.Results The operation time in the observation group was(21.8±3.4)min,which was significantly shorter than that in the control group[(25.7±6.8)min,t=-4.192,P=0.000].The stone escape rate in the observation group was 7.4%(5/68),which was significantly lower than that in the control group[27.3%(18/66),χ^(2)=9.347,P=0.002].The stone clearance rate in the observation group was 97.1%(66/68),which was significantly higher than that in the control group[75.8%(50/66),χ^(2)=13.069,P=0.000].The postoperative fever rate in the observation group was 7.4%(5/68),which was lower than that in the control group[19.7%(13/66),χ^(2)=4.389,P=0.036].The ureteral injury rate in the observation group was 4.4%(3/68),which was lower than that in the control group[16.7%(11/66),χ^(2)=5.376,P=0.020].The incidence of ureteral stricture in the observation group was 2.9%(2/68),which was lower than that in the control group[13.6%(9/66),χ^(2)=5.084,P=0.024].Conclusion The“three-step method”reduces the risk of stone migration to the kidney and the incidence of intraoperative changes to flexible ureteroscopic lithotripsy in the treatment of upper and middle ureteral stones,with advantages of short operative time,clinical safety and effectiveness,and high stone clearance rates.

关 键 词：封堵导管 钬激光碎石 输尿管篮型取石套件 输尿管中上段结石 

分 类 号：R699.4[医药卫生—泌尿科学]