输尿管软镜钬激光碎石联合排石颗粒治疗肾结石的临床研究

目的 观察输尿管软镜钬激光碎石联合应用排石颗粒治疗肾结石的疗效.方法 将本科室2013年8月至2015年8月收治的192例行输尿管软镜钬激光碎石的肾结石患者随机分为观察组(101例)和对照组(91例).结石最大直径约<25 mm,术前均行泌尿系平片(KUB)+静脉尿路造影(IVU).对照组60例结石位于上盏、中盏或肾盂内,41例位于下盏或多个肾盏,采用输尿管软镜钬激光碎石.观察组60例结石位于上盏、中盏或肾盂内,31例位于下盏或者多个肾盏.采用输尿管软镜钬激光碎石术,术后联合排石颗粒治疗.术后4周KUB平片或者双肾CT平扫,评估结石清除率.结果 全部患者进镜顺利并成功碎石.观察组4周后总排石成功率为97.0% (98/101) ,下盏及多盏结石排净率为97.6%(40/41),肾中上盏及肾盂内结石的排石率为96.7%(58/60);对照组4周后总排石成功率为90.1% (82/91),下盏及多盏结石排净率为80.6%(25/31),肾中上盏及肾盂内结石的排石率为95.0%(57/60) .两组相比总排石率差异具有显著统计学意义(P<0.05),下盏及多盏结石排净率差异具有显著统计学意义(P<0.05),肾中上盏及肾盂内结石的排石率无明显差异(P>0.05).结论 输尿管软镜激光碎石治疗肾结石尤其是肾下盏结石术后联用排石颗粒可明显提高排石率.

Clinical research on flexible ureteroscopy and laser lithotripsy combined with Paishi granule in treatment of patients with renal calculi

Objectives To observe the efficacy of flexible ureteroscopy and laser lithotripsy combined with Paishi granule for patients with renal calculi.Methods A total of 192 patients with renal calculi underwent ureteral soft holmium laser kidney stone in our hospital between August 2013 and August 2015 were randomly divided into observation group (101 cases) and control group (91 cases).The largest stone diameter of patients were less 25 mm.All patients were examined by preoperative kidney ureter bladder (KUB) and intravenous urography (IVU).There were 60 cases of stones located on the upper calyceal, the middle calyceal and inside the pelvis and 41 cases in the lower calyxcalyces or more in control group, which were treated by flexible ureteroscope holmium laser lithotripsy.There were 60 patients had calculi in the upper calyceal, the middle calyceal and inside the pelvis and 31 cases located in the lower calyxcalyces or more in observation group, which were treated by flexible ureteroscope holmium laser surgery and Paishi granule after surgery.The rate of stone clearance were assessed in two groups by KUB or CT scan after four weeks.Results The procedures of flexible ureteroscopy and laser lithotripsy succeeded in all patients.After four weeks, the total rate of stone clearance was 97.0% (98/101) in observation group and that in lower calyx and multiple calyxes 97.6% (40/41) and in the upper calyceal, the middle calyceal and inside the pelvis 96.7% (58/60), and those in control group were 90.1% (82/91), 80.6% (25/31) and 95.0% (57/60).The total rate of stone clearance in the two groups are significant differences(P<0.05).The stone-free rates of lower calyx and multiple calyxes were significantly different(P<0.05).There were no significant difference in the renal calyx and a row of stone rate pelvis stones between two groups(P>0.05).Conclusions Flexible ureteroscopy and laser lithotripsy combined with Paishi granule for renal calculi can significantly improve the evacuation rate of the stone especially when the stones at the lower calyx or in multiple calyxes.