钬激光碎石术与体外冲击波碎石术治疗输尿管结石的疗效比较

目的　比较输尿管镜钬激光碎石术与体外冲击波碎石术 (ESWL)治疗输尿管结石的有效性和安全性。　方法　采用输尿管镜钬激光碎石术治疗输尿管结石 15 9例 16 8侧 ,其中结石直径≥ 1cm者 76侧 ,<1cm者 92侧。ESWL治疗输尿管结石 319例 334侧 ,其中结石直径≥ 1cm者 14 3侧 ,<1cm者 191侧。比较两组手术时间 结石排净率 手术并发症发生率指标的差异。　结果　对直径≥ 1cm和 <1cm的输尿管结石钬激光碎石术治疗平均手术时间分别为 5 8min和 4 3min ,短于ESWL的平均手术时间 6 8min和 5 6min(P <0 .0 1) ;钬激光碎石术对直径≥ 1cm的输尿管结石 3个月结石排净率为 92 % ,高于ESWL的 6 1% (P <0 .0 1) ;对直径 <1cm的输尿管结石钬激光碎石术和ESWL的 3个月结石排净率分别为 95 %和 85 % (P >0 .0 5 )。钬激光碎石术组并发症发生率为 4 .8%( 8/ 16 8) ,ESWL组无明显并发症发生。　结论　输尿管镜钬激光碎石术治疗直径≥ 1cm的输尿管结石疗效明显优于ESWL ,而直径 <1cm的结石二者疗效差异无显著性 ,ESWL为直径 <1cm结石的首选治疗方法

Treatment of ureteral calculi:comparison between ureteroscopy with holmium:YAG laser lithotripsy and extracorporeal shock wave lithotripsy

Objective To compare the safety and efficacy of ureteroscopy with holmium:YAG laser lithotripsy and extracorporeal shock wave lithotripsy (ESWL) for ureteral calculi. Methods 159 patients (168 sides) underwent ureteroscopy with holmium:YAG laser lithotripsy,including 76 sides of calculi 1 cm or greater and 92 sides of calculi less than 1 cm in diameter.319 patients (334 sides) underwent ESWL,including 143 sides of calculi 1 cm or greater and 191 sides of calculi less than 1 cm.The operation time,stone free rate and incidence rate of complications were compared between the 2 groups. Results The mean operation time of ureteroscopy with holmium:YAG laser lithotripsy for calculi 1 cm or greater and less than 1 cm was 58 min and 43 min,respectively,which were shorter than 68 min and 56 min with ESWL (both P <0.01). The stone free rate after 3 months in patients with 1 cm or greater stone was 92% for ureteroscopy with holmium:YAG laser lithotripsy. It was higher than 61% with ESWL ( P <0.01). As for calculi less than 1 cm, the stone free rate with holmium:YAG laser lithotripsy and ESWL were 95% and 85%,respectively ( P >0.05).The complication rate was 4.8% (8/168) in the group of ureteroscopy with holmium:YAG laser lithotripsy,while in ESWL group no complication occurred. Conclusions Our study demonstrates that ureteroscopy with holmium:YAG laser lithotripsy for calculi 1 cm or greater in diameter is more effective than ESWL,but no difference between the 2 groups for calculi less than 1 cm.ESWL can be used as the first line therapy for calculi less than 1 cm in diameter.