目的 探讨提高输尿管镜下钬激光碎石术(USHL)治疗输尿管上段结石成功率的综合策略.方法 我院2009年8月~2012年6月开展USHL治疗输尿管上段结石,以2011年1月1日为界,总结前期47例输尿管上段结石(A组)的USHL治疗经验,结合相关专业文献形成一套USHL处治输尿管上段结石的综合指导策略,并应用于后期87例输尿管上段结石(B组)的USHL临床治疗.对比观察策略指导前后碎石满意度,碎石时结石是否有向肾盂漂移出视野,结石漂移及是否被动改变术式等指标情况.结果 策略指导前后两组碎石满意度、结石漂移等指标情况对比,差异有高度统计学意义(χ2=13.90,P < 0.01).结论 USHL治疗输尿管上段结石时,全面合理的综合策略指导可以明显提高输尿管镜下碎石成功率.%Objective To discuss the strategies in improving thesuccess rate of ureteroscopically holmium laser lithotripsy (USHL) in the treatment of upperureteral calculi. Methods 134 cases of patients suffering from the upper ureteral calculi, who had accepted the treatment on USHL to upper ureteral calculi from August 2009 to June 2012 were studied. In the study, January 1, 2011 as a time boundary line, all the cases had been divided into two groups, the group A (47 cases of the early group, which had not been given the comprehensive strategic guideline) and the group B (87 cases of later group, which had been given the comprehensive strategy guidline summarized out from group A). The satisfaction of USHL to upper ureteral calculi, the fragment of stone drifted upward into renal pelvis for some reason and the situation that some cases were changed operation mode into other operation method because of the unsuccessful factor were observed and compared for the two groups. Results The results suggest there was a significant statistically difference between group A and group B (X2 = 13.90, P < 0.01) on the satisfaction of USHL to upper ureteral calculi, the fragment of stone drifted upward into renal pelvis. Conclusion Comprehensive and reasonable strategic guideline can improve the success rate of ureteral hard microscopically holmium laser lithotripsy in the treatment of upper ureteral calculi.
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