顺行和逆行钬激光碎石术治疗嵌顿性输尿管上段结石的疗效比较  

Compare thetreatment efficacy between anterograde and retrograde Holmium laser lithotripsy for large proximal impacted ureteral stones

作　　者：王杜渐[1] 吕建林[1] 周兴祝[1] 柳发德[1] 唐庆来[1] 纪俊标[1] 王清[1] 

机构地区：[1]南京医科大学附属江宁医院泌尿外科,南京211100

出　　处：《激光杂志》2015年第5期34-37,共4页Laser Journal

摘　　要：通过分析比较顺行和逆行钬激光碎石术的患者治疗情况,为嵌顿性输尿管上段结石(大于1.5cm)治疗方案的合理选择提供依据。2011年9月至2015年1月,我们对临床诊断为嵌顿性输尿管上段结石(>1.5 cm)的患者72例,分别采用顺行和逆行钬激光碎石术为主的二种方法进行治疗,对其临床疗效进行比较。其中,顺行钬激光碎石采用Mini-PCNL的方法(Mini-PCNL组),逆行钬激光碎石分为软镜组(FURS组)和硬镜组(URSL组)。采用随机对照研究,并应用效率商(EQ)评估三组治疗方法的碎石效率。三组患者术前和术后各项治疗数据与不良反应均进行记录。Mini-PCNL组、URSL组和FURS组的一期清石率分别为81.8%、54.2%和69.2%。治疗三月后,三组总的清石率分别为95.4%、66.7%和100%,Mini-PCNL组和FURS组总清石率较URSL组比较,差异有统计学意义(P<0.05)。三组的EQs值分别为0.84、0.43和0.62。三组患者术后住院时间7.50±2.15天、3.71±1.92天和3.61±1.35天,URSL组和FURS组较Mini-PCNL组比较,差异有统计学意义(P<0.05)。另外,URSL组有2例发生输尿管穿孔后,分别改腹腔镜和开放手术。对于体积较大嵌顿性输尿管上段结石(>1.5 cm),URSL结石清石率低,并发症多。Mini-PCNL和FURS治疗效果明显,安全性高,结石清除率显著,值得借鉴。FURS较Mini-PCNL,术后患者恢复更快。To compare the treatment efficacy and analysis treatment planning options between anterograde and retrograde Holmium laser lithotripsy for large proximal impacted ureteral stones( greater than 1. 5 cm). From September2011 to November 2015,72 patients with large proximal ureteral stones were considered for this study. Patients who is in the Anterograde lithotripsy group were treated with minimally invasive percutaneous antegrade ureterolithotripsy( Mini-PCNL) and in Retrograde lithotripsy group were treated with Ureteroscopic lithotripsy( URSL) and flexible ureteroscopy lithotripsy( FURS). The efficiency quotient( EQ) was calculated to specifically address the efficiency for these three techniques. All preoperative and postoperative data for these groups were recorded. The lithotripsy device was used Holmium laser lithotripsy. The initial stone-free rate was 81. 8% in the mini-PCNL group,41. 4% in the URSL group and 69. 2% in the FURS group( p = 0. 131). However,the overall stone-free rate was 95. 4% in the mini-PCNL group,66. 7% in the URSL group and 100% in FURS group after3-month follow-up( P < 0. 001). The EQs for the Mini-PCNL,URSL and FURS groups were 0. 84,0. 43 and 0. 62 respectively. Statistical difference for postoperative hospitalization time was significant between URSL,FURS group and Mini-PCNL group( P < 0. 001). No serious complication occurred in the there group. This investigation demonstrated that the Mini-PCNL and FURS remains a safe and efficient treatment option for proximal impacted ureter stone,especially when the stone size is>15 mm.

关 键 词：经皮肾镜术 输尿管硬镜碎石术 输尿管软镜碎石术 钬激光 嵌顿性 结石 

分 类 号：R693.4[医药卫生—泌尿科学]