组合式输尿管软镜钬激光碎石术治疗肾和输尿管上段结石的疗效分析

目的 探讨组合式输尿管软镜钬激光碎石术治疗肾和输尿管上段结石的临床效果.方法 选取2013年11月至2015年12月本院泌尿外科采用组合式输尿管镜联合钬激光碎石术治疗的70例肾和输尿管上段结石患者进行回顾性分析,其中输尿管上段结石患者28例,肾结石42例,在全麻或者脊麻下进行手术治疗.结果 70例患者,手术时间45～ 88 min,平均手术时间(61.4-12.8)min,排石时间2～14d,平均排石时间(8.4±3.9)d,术后72h疼痛程度(VAS)评分2～7分,平均VAS评分(4.04±1.36)分,一次性手术成功碎石62例患者,碎石成功率88.57％(62/70).28例输尿管上段结石患者的手术时间、平均排石时间、术后疼痛发作程度VAS评分均显著的低于肾结石患者(P＜0.05);输尿管上段结石患者的碎石成功率92.86％(26/28)略高于肾结石患者的85.71％(36/42),但差异无统计学意义(P＞0.05).结论 组合式输尿管软镜钬激光碎石术治疗肾和输尿管上段结石具有较好的临床效果及安全性.

Effect of combined treatment of renal and upper ureteral calculi with holmium laser lithotripsy

Objectives To investigate the clinical effect of combined treatment of renal and upper ureteral calculi with holmium laser lithotripsy combined with flexible laser lithotripsy.Methods Clinical data of 70 patients with renal and ureteral calculi who underwent ureteroscopy combined holmium laser lithotripsy from November 2013 to December 2015 in our hospital were analyzed retrospectively,including 28 cases of ureteral calculi and 42 cases of kidney stones.All patients were given general anesthesia or spinal anesthesia for surgery.Results The operation time was 4588 min,the average operation time was (61.4 ± 12.8) min) time of removing calculus was 2 ～ 14 d,the average time of removing calculus was (8.4 ± 3.9) d,72 h postoperative pain (VAS) score was 2 ～ 7 points,an average VAS score was (4.04 ± 1.36) min,and the success rate of one stage for all patients was 88.57％ (62/70).Operation time,average waiting time of stone,postoperative pain (VAS) scores of 28 patients with ureteral stones were significantly lower than patients with kidney stones (P ＜ 0.05).Lithotripsy success rate of patients with ureteral calculi (92.86％) was slightly higher than the upper section of patients with kidney stones (85.71％),but the difference was not statistically significant(P＞ 0.05).Conclusions Combined flexible ureteroscope holmium laser lithotripsy treatment of renal and ureteral calculi has better clinical efficacy and safety.