输尿管镜气压弹道碎石术与经皮肾穿刺钬激光碎石术治疗输尿管上段结石临床疗效分析

目的探讨输尿管镜气压弹道碎石术与经皮肾穿刺钬激光碎石术两种手术方式治疗输尿管上段结石的临床疗效。方法选取2010年1月~2012年12月我院收治的输尿管上段结石患者126例进行随机分组,输尿管镜气压弹道组64例,经皮肾穿刺钬激光组62例。结果气压弹道组的手术时间为(45.30±3.20)min,明显长于钬激光组(28.61±2.13)min,差异有统计学意义(P0.001);两组患者术后住院时间差异无统计学意义(P0.05)。气压弹道组的术后出血量为(31.53±6.24)ml,明显多于钬激光组(16.16±3.13)ml,差异有统计学意义(P0.001)。术后3d复查结石清除情况,气压弹道组结石清除率70.31%,低于钬激光组85.48%,差异有统计学意义(P0.05);术后1个月复查结石清除情况,气压弹道组结石清除率78.13%,低于钬激光组95.16%,差异有统计学意义(P0.05);术后气压弹道组并发症发生率29.69%,高于钬激光组24.19%,差异无统计学意义(P0.05)。结论超声引导经皮肾穿刺钬激光碎石术治疗输尿管上段结石效果良好,具有手术时间短、结石清除率高、并发症少等优点,值得临床上进一步研究和推广应用。

The Clinical Effect Analysis of Ureteroscopy Pneumatic Lithotripsy and Percutaneous Holmium Laser Lithotripsy for Upper Ureteral Calculi

Objective To investigate the clinical efficacy of ureteroscopy pneumatic lithotripsy and per- cutaneous holmium laser lithotripsy for the treatment of upper ureteral calculi. Methods Patients in our hospital from January 2010 to December 2012 were chosen for the study of the upper ureteral calculi objects. 126 patients were selected according to the standard. After randomization, there were 62 cases in percutaneous holmium laser lithotripsy group and 64 cases in ureteroscopy pneumatic lithotripsy group. Results The operative time of pneumatic lithotripsy group was （45.30 ± 3.20） min, which was significantly longer than the holmium laser group, （28.61 ± 2. 13） min （P 〈 0.05）. Postoperative hospital stay between the two groups was not significant different （P 〉 0. 05）. The postoperative bleeding of pneumatic lithotripsy group was （31.53 ± 6.24）ml, which was significantly more than the holmium laser group, （ 16.16 ± 3.13 ） ml （ P 〈 0.05 ）. The 3-day and 1-month stone clearance rate of the pneumatic lithotripsy group and the holmium laser group was 70.31% vs. 85.48 %, and 78.13% vs. 95.16 % respectively （P 〈 0.05）. And the incidence of postoperative complications was 29.69% vs. 24.19% （P 〉 0.05）. Conclusion Ultrasound-guided percutaneous holmium laser lithotripsy for upper ureteral calculi is proven to be good effect, with shorter operative time, more complete stone clearance rate fewer complications, which is worth further study and clinical application.