硕通镜与输尿管软镜治疗CT值≥1000HU输尿管上段结石的疗效和安全性比较  

Comparison of the efficacy and safety of ShuoTong ureteroscopy and flexible ureteroscopy in the treatment of upper ureteral calculi with CT numberical value greater than 1000 HU

作　　者：赖龙辉 张文炤 林达伟 白培德 刘正升[1] 王涛[1] 崔澍 王志平[2] 邢金春[1] 陈斌[1] Lai Longhui;Zhang Wenzhao;Lin Dawei;Bai Peide;Liu Zhengsheng;Wang Tao;Cui Shu;Wang Zhiping;Xing Jinchun;Chen Bin(Department of Urology,The First Affiliated Hospital,Xiamen University,Xiamen 361003,China;Department of Urology,Second Hospital of Lanzhou University,Key Laboratory of Urological Diseases Research of Gansu Province,Lanzhou 730000,China;Third Clinical Medical College of Fujian Medical University,FuZhou 350122,China)

机构地区：[1]厦门大学附属第一医院泌尿外科,厦门361003 [2]兰州大学第二医院泌尿外科甘肃省泌尿系统疾病研究重点实验室,兰州730000 [3]福建医科大学第三临床医学院,福州350122

出　　处：《中华泌尿外科杂志》2023年第2期115-120,共6页Chinese Journal of Urology

基　　金：厦门市医疗卫生指导性项目(3502Z20214ZD1007)。

摘　　要：目的比较硕通镜与输尿管软镜联合钬激光碎石术治疗CT值≥1000HU输尿管上段结石的临床疗效和安全性。方法回顾性分析厦门大学附属第一医院2018年1月至2020年11月收治的148例CT值≥1000HU的输尿管上段结石患者的临床资料。61例行硕通镜钬激光碎石术(硕通镜组),男45例,女16例;年龄(48.3±12.7)岁;体质量指数(24.7±2.7)kg/m^(2);结石位于左侧40例,右侧21例;结石直径(1.50±0.45)cm,结石CT值(1288.8±179.0)(1017~1738)HU。87例行输尿管软镜钬激光碎石术(软镜组),男58例,女29例;年龄(48.5±13.0)岁;体质量指数(24.1±3.8)kg/m^(2);结石位于左侧56例,右侧31例;结石直径(1.45±0.40)cm,结石CT值(1311.3±188.9)(1009~1817)HU。两组的基线资料比较差异均无统计学意义(P>0.05)。硕通镜组在直视下置入硬性输尿管通道鞘和标准镜(F7.5/11.5),退出标准镜,留置通道鞘,置入碎石镜(F4.5/6.5)和钬激光[功率为8~30 W(0.4~1.0 J/20~30 Hz)],采用"蚕蚀法"边碎石边吸出结石碎片。软镜组先用输尿管硬镜(F8/9.8)探查患侧输尿管,置入导丝后留置输尿管软镜鞘,再置入输尿管软镜(F8)行钬激光碎石术,采用套石篮取出较大结石碎片。术后常规留置输尿管支架管。术后第1天和1个月行影像学检查,评估结石清除率。无残留结石或结石直径≤0.4 cm且无尿路感染或任何症状定义为结石清除。比较两组的手术时间、手术出血量、一期输尿管通道鞘置入成功率、术后并发症发生率、术后第1天和1个月结石清除率、术后住院时间、住院费用。按结石最大直径≥1.5 cm和<1.5 cm进行亚组分析,比较硕通镜组和软镜组的手术时间、术后第1天和1个月结石清除率。结果硕通镜组手术时间短于软镜组(40.10 min与49.43 min,P=0.020),术后并发症发生率低于软镜组[3.3%(2/61)与13.8%(12/87),P=0.031],术后第1天结石清除率显著高于软镜组[60.7%(37/61)与25.3%(22/87),P<0.01],住院费用低于软镜Objective To compare the clinical efficacy and safety of Shuo Tong ureteroscopy(ST-URS)and flexible ureteroscope(FURS)combined with holmium laser lithotripsy in the treatment of upper ureteral calculi with CT numerical value≥1000 HU.Methods A retrospective analysis of the clinical data of patients of upper ureteral calculi with CT numberical value≥1000 HU in the First Affiliated Hospital of Xiamen University was made from January 2018 to November 2020.There were 61 cases treated with ShuoTong ureteroscopy holmium laser lithotripsy(ST-URS group),including 45 males and 16 females,with 40 on the left and 21 on the right,age of(48.3±12.7)years,body mass index of(24.7±2.7)kg/m^(2),the diameter of stone of(1.50±0.45)cm,and the CT numberical value of(1288.8±179.0)(1017-1738)HU.There were 87 cases were treated with flexible ureteroscopy holmium laser lithotripsy(FURS group),including 58 males and 29 females,with 56 on the left and 31 on the right,age of(48.5±13.0)years,body mass index of(24.1±3.8)kg/m2,the stone diameter of(1.45±0.40)cm,and the CT numberical value of(1311.3±188.9)(1009-1817)HU.There were no significant differences in gender,age,body mass index,the location of stone,the diameter of stone and the CT numberical value of stone(P>0.05)between the two groups.For ST-URS group,a rigid ureteral channel sheath and standard mirror(F7.5/11.5)were placed under direct vision,exiting the standard mirror,leaving the channel sheath,inserting a lithotripsy mirror(F4.5/6.5)and a holmium laser[Power:8-30 W(0.4-1.0 J/20-30 Hz)],and withdrawing the stone fragments after crushing the stone by"nibbling method".For FURS group,a hard ureteroscope(F8/9.8)was used to explore the lesion side of the ureter,inserting a guide wire and placing a soft ureteral sheath,then inserting a flexible ureteroscope(F8)for holmium laser lithotripsy,and useing a stone basket to remove larger stone fragments.Ureteral stent was routinely indwelled after the operation.On the day 1 and 1 month after the operation,imaging examinations were pe

关 键 词：输尿管结石 硕通镜 输尿管软镜 输尿管上段结石 CT值 钬激光碎石术 

分 类 号：R699.4[医药卫生—泌尿科学]