经尿道钬激光联合锥型取石网(Stone cone)治疗输尿管上段结石

目的探讨经尿道钬激光联合锥型取石网(Stone cone)治疗输尿管上段结石的有效性和安全性。方法回顾性分析我院2018年4月~2019年6月经尿道输尿管镜治疗输尿管上段结石69例的临床资料,其中33例采用钬激光联合锥型取石网(观察组),36例单用钬激光(对照组)。比较2组手术时间、结石逃逸率、清石率、输尿管损伤率、术后发热率和术后输尿管狭窄率。结果观察组手术时间(21.8±5.6)min,明显短于对照组(46.4±4.7)min(t=-19.814,P=0.000);结石逃逸率9.1%(3/33),明显低于对照组47.2%(17/36)(χ^2=12.162,P=0.000);清石率90.9%(30/33),显著高于对照组52.8%(19/36)(χ^2=12.162,P=0.000)。2组输尿管损伤率分别为6.1%(2/33)、8.3%(3/36),无统计学差异(χ^2=0.000,P=1.000);术后发热率分别为6.1%(2/33)、11.1%(4/36),无统计学差异(χ^2=0.100,P=0.752);术后输尿管狭窄率分别为3.0%(1/33)、5.6%(2/36),无统计学差异(χ^2=0.000,P=1.000)。结论经尿道钬激光联合锥型取石网治疗输尿管上段结石安全、有效,在手术时间、结石逃逸及结石清除率方面优于单用钬激光。

Transurethral Ureteroscopic Holmium Laser Lithotripsy Combined With Stone Cone for Treatment of Upper Ureteral Calculi

Objective To study the efficacy and safety of transurethral ureteroscopic holmium laser lithotripsy combined with application of stone cone in the treatment of upper ureteral calculi.Methods A total of 69 cases of upper ureter calculi treated by transurethral ureteroscopic lithotripsy from April 2018 to June 2019 in our hospital were analyzed retrospectively.The cases were divided into observation group(33 cases of holmium laser combined with stone cone)and control group(36 cases of holmium laser only).The operation time,rate of stone escape,rate of stone clearance,rate of ureteral injury,rate of postoperative fever and rate of postoperative ureteral stricture were compared.Results As compared to the control group,the observation group had significant shorter operation time(21.8±5.6)min vs.(46.4±4.7)min,t=-19.814,P=0.000],less rate of stone escape9.1%(3/33)vs.47.2%(17/36),χ^2=12.162,P=0.000],and higher rate of stone clearance90.9%(30/33)vs.52.8%(19/36),χ^2=12.162,P=0.000].As for the two groups,the ureteral injury rates were 6.1%(2/33)and 8.3%(3/36),without statistical difference(χ^2=0.000,P=1.000);the postoperative fever rates were 6.1%(2/33)and 11.1%(4/36),without statistical difference(χ^2=0.100,P=0.752);the postoperative ureteral stricture rates were 3.0%(1/33)and 5.6%(2/36),without statistical difference(χ^2=0.000,P=1.000).Conclusion Transurethral ureteroscopic holmium laser lithotripsy combined with stone cone has good efficacy and safety in the treatment of upper ureteral calculi,which is superior to only use holmium laser in terms of operation time,stone escape and stone clearance.