头高臀低截石位联合利尿药在输尿管镜碎石术中的临床疗效观察

目的 探讨头高臀低截石位联合利尿药对输尿管镜下钬激光碎石治疗嵌顿性输尿管上段结石的临床疗效和指导意义.方法 选取93例嵌顿性输尿管上段结石患者作为研究对象,按随机数字表法将其分为A组(头高臀低截石位联合利尿药),B组(头高臀低截石位),C组(水平截石位,即对照组),每组31例,三组患者均行输尿管镜钬激光碎石术,使用钬激光(200 μm或365 μm)进行碎石,将钬激光的参数设置为低能量(0.6 J)和高频率(30 Hz),分析比较三组患者一次性结石清除成功率、术中出血量、手术时间及并发症的发生情况.结果 三组患者的术中出血量及手术并发症(严重感染、发热、穿孔等)情况比较均差异无统计学意义(P＞0.05),A组患者的手术时间显著低于B组和C组(P＜0.001).A组的一次性结石清除成功率明显高于B组和C组(P＜0.05).结论 头高臀低截石位联合利尿药在输尿管镜治疗嵌顿性输尿管上段结石手术中的应用总体上是安全有效的,具有手术时间短、一次性结石清除成功率较高等特点,值得临床上推广和应用.

Clinical efficacy of high head and low hip with lithotomy position by combining with diuretic in ureteroscopic lithotripsy

Objective To investigate the clinical efficacy and guiding significance of high head and low hip with lithotomy position by combining with diuretic in the treatment of upper blunt ureteral calculi with ureteroscopic holmium laser lithotripsy.Methods A total of 93 patients with upper blunt ureteral calculi were selected and randomly assigned into group A (high head and low hip with lithotomy position by combining with diuretic),group B (high head and low hip with lithotomy position),and group C (the level of lithotomy position,the control group),31 cases in each group.All three groups of patients underwent ureteroscopic holmium laser lithotripsy with 200 μm or 365 μm laser,and low energy (0.6 J) and high frequency (30 Hz) were set.The success rate of one-time stone removal,the blood loss during operation,operation time and the occurrence of complications were compared among three groups.Results There were no significant differences in the blood loss and complications (severe infection,fever,perforation,etc.) among three groups (P ＞0.05).The operation time of patients with high head and low hip with lithotomy position by combining with diuretic group was significantly shorter than that of the high head and low hip with lithotomy position group and the horizontal level of lithotomy position group (P ＜ 0.001).The success rate of one-time stone removal in high head and low hip with lithotomy position by combining with diuretic group was significantly higher than that of the high head and low hip with lithotomy position and the horizontal level of lithotomy position group(P ＜ 0.05).Conclusions The application of high head and low hip with lithotomy position by combining with diuretic in ureteroscopy for the treatment of upper blunt ureteral calculi is safe and effective,with short operation time and high success rate of one-time stone removal,which is worthy of clinical application and promotion.