三种微创碎石术治疗复杂性输尿管上段结石的临床对比研究

目的:探讨经皮肾镜、经尿道输尿管镜气压弹道碎石术及经尿道输尿管镜钬激光碎石术治疗复杂性输尿管上段结石的临床疗效及安全性。方法:选取150例复杂性输尿管上段结石患者,随机分为A组、B组及C组,每组50例,分别行经皮肾镜、经尿道输尿管镜气压弹道碎石术及经尿道输尿管镜钬激光碎石术。对比3组患者手术时间、术后血红蛋白减少值、住院时间、一次性结石清除率、二次手术率、手术前后患侧肾脏肾小球滤过率水平、术后并发症发生率等。结果:A组手术时间显著短于B、C组(P0.05);B、C组患者术后血红蛋白减少值、住院时间均显著优于A组(P0.05);3组患者一次性结石清除率、二次手术率及术后患侧肾脏肾小球滤过率水平差异无统计学意义(P0.05);C组患者术后并发症发生率显著低于A、B组(P0.05)。结论:相较经皮肾镜、经尿道输尿管镜气压弹道碎石术,经尿道输尿管镜钬激光碎石术治疗复杂性输尿管上段结石可有效减少术中创伤、加快术后康复进程,并有助于降低术后并发症发生风险。

Clinical comparative study of three kinds of minimally invasive lithoclasty in the treatment of complex upper ureteral calculi

Objective:To investigate the differences of clinical effects and safety of three kinds of minimally invasive lithoclasty in the treatment of complex upper ureteral calculi including percutaneous nephroscopic pneumatic lithotripsy,transurethral ureteroscopic pneumatic lithotripsy and transurethral ureteroscopic holmium laser lithotripsy.Methods:One hundred and fifty patients with complex upper ureteral calculi were chosen and randomly divided into 3 groups including group A (50 patients) with percutaneous nephrolithotomy,group B (50 patients) with transurethral ureteroscopic pneumatic lithotripsy and group C (50 patients) with transurethral ureteroscopic holmium laser lithotripsy.The operation time,postoperative hemoglobin reduction value,hospitalization time,calculi clearance rate for first time,re-operation incidence,the levels of the ipsilateral glomerular filtration rate before and after operation and postoperative complication incidence of 3 groups were compared.Results:The operation time of Group A was significantly shorter than Group B and Group C (P<0.05).The intraoperative hemoglobin reduction value and hospitalization time of Group B and Group C was significantly better than Group A (P<0.05).There was no significant difference in calculi clearance rate for first time,re-operation incidence and the levels of ipsilateral glomerular filtration rate after operation among 3 groups (P>0.05).The postoperative complication incidence of Group C was significantly lower than Group A and Group B (P<0.05).Conclusions:Compared with percutaneous nephroscopic pneumatic lithotripsy and transurethral ureteroscopic pneumatic lithotripsy,transurethral ureteroscopic holmium laser lithotripsy in the treatment of complex upper ureteral calculi can efficiently reduce intraoperative trauma,accelerate the rehabilitation process,and be helpful to reduce the risk of postoperative complications.