拦截网篮或封堵器和无封堵装置在治疗输尿管上段结石手术中的前瞻性比较

目的比较经输尿管镜拦截网篮或封堵器固定和不用任何封堵装置的情况下，用钬激光碎石治疗输尿管上段结石的疗效及安全胜。方法2010年1月至2012年6月前瞻．胜研究应用拦截网篮或封堵器和不用任何封堵装置进行输尿管镜下钬激光碎石治疗输尿管上段结石240例，并对临床资料进行分析。将患者随机分3组，每组80例。A组使用N—trap网篮，B组使用封堵器，C组不用任何封堵装置。结果A组：77例成功完成拦截网篮固定下钬激光碎石取石，成功率96.3％（77／80）。2例在进镜时结石上漂，术中未发现结石；1例输尿管近端扩张明显，拦截网篮未固定住结石，上移至肾盂。B组：72例成功完成封堵器固定下钬激光碎石，成功率90．0％（72／80）。2例在进镜时结石上移，术中未发现结石；3例息肉包裹的结石在放置封堵器前出现结石漂移至肾盂；3例在放置封堵器时出现结石移至肾盂。C组：60例成功完成单纯钬激光碎石，成功率75．0％（60／80）。4例在进镜时结石上移，术中未发现结石；16例边碎石边上移，最终较大碎块进入肾盂。三组均未发生输尿管撕裂、黏膜袖状剥脱、菌血症等并发症。结论经输尿管镜拦截网篮或封堵器固定下用输尿管镜下钬激光碎石治疗输尿管上段结石，结石不易上漂，原位碎石效率高，均是治疗输尿管上段结石安全、高效的方法。

A randomized prospective study to evaluate the efficacy of N-Trap basket,ureteral occlusion device and no ureteral occlusive device for upper ureteral stones

Objective To evaluate the efficacy of N-Trap basket, ureteral occlusion device and no ureteral occlusive device during ureteroscopic lithotripsy using holmium laser to treat upper ureteral stones. Methods 240 patients who underwent ureteroscopic lithotripsy using holmium laster to treat upper ureteral stones combined with N-Trap basket, ureteral occlusive device and no ureteral occlusive device were prospectively conducted from January 2010 to June 2012. All patients were divided into 3 group at randomy. There were 80 patients in each group. N-Trap basket was used in group A, ureteral occlusive device was used in group B and no ureteral occlusive device was used in group C. Results Group A： The stone-free rate was 96.3 % （77/80）. Stone migration occurred in 2 cases. The expansion of proximal ureter made N-Trap basket not fix stone in 1 case. Group B： The stone-free rate was 90.0% （72/80）. Stone migration occurred in 8 cases, including 5 cases happened before occlusive device placing and 3 cases during occlusive device placing. Group C： The stone-free rate was 75.0% （60/80）. Stone migration occurred in 20 cases, that happened during lithotripsy in 16 cases. Group A and B showed significantly higher success rate in preventing the stone migration than group C （P〈0.05）. There were neither peri-operative complications nor septicemia in our study. Conclusions The use of N-Trap basket or ureteral occlusive device could prevent the stone migration during ureteroscopic lithotripsy with holmium laser to treat upper ureteral stones. The stone-free state could possibly be achieved with the aid of N-Trap basket and ureteral occlusion device.