目的：探讨输尿管镜联合超声碎石清石系统（ EMS第5代）治疗复杂输尿管结石的临床疗效和安全性。方法回顾性比较我院2007年9月～2014年10月手术治疗63例复杂输尿管结石的临床资料，按手术方式分为2组：30例行输尿管镜联合超声碎石清石系统碎石术为超声碎石组（ultrasonic lithotripsy，UL），33例行输尿管镜联合气压弹道碎石术为气压弹道碎石组（pneumatic lithotripsy， PL）。比较2组手术成功率、手术时间、结石完全排出时间，并记录不良事件发生情况。结果 UL组手术成功率93．3％（28／30），明显高于PL组72．7％（24／33）（χ2＝4．630，P＝0．031）。 UL组手术时间（35．9±8．6）min，明显少于PL组（47．9±6．7）min（t＝－6．208，P＝0．000）。 UL组术后结石完全排出时间（16．7±6．7）d，明显短于PL组（27．0±6．9）d（t＝－5．999，P＝0．000）。2组术后并发症发生率分别为3．3％（1／30）和12．1％（4／33），无统计学差异（χ2＝0．676，P＝0．411）。随访57例，时间1～85个月，中位随访时间39个月，无输尿管狭窄等远期并发症发生。结论输尿管镜联合超声碎石清石系统治疗复杂输尿管结石安全、有效，具有碎石效率高，手术时间短的优点。%Objective To investigate the curative effect and safety of ureteroscopy combined with ultrasonic lithotripsy ( EMS fifth generation) for complicated ureteral calculi. Methods A total of 63 patients with complicated ureteral calculi underwent operations in our hospital between September 2007 and October 2014, including 30 cases of ureteroscopy combined with ultrasonic lithotripsy ( UL group) and 33 cases of ureteroscopy combined with pneumatic lithotripsy ( PL group) .The successful rate of operation, operation time, time to calculi expulsion and complication were compared between the two groups.Adverse effects were recorded. Results The successful rate of operation was 93.3%(28/30) in the UL group and 72.7%(24/33) in the PL group (χ2 =4.630, P=0.031).The operation time was (35.9 ±8.6) min in the UL group and (47.9 ±6.7) min in the PL group (t=-6.208, P=0.000).The time for calculi expulsion was (16.7 ±6.7) d in the UL group and (27.0 ±6.9) d in the PL group (t=-5.999, P=0.000).There was no significant difference in complication rate between the two groups [3.3% (1/30) vs.12.1% (4/33),χ2 =0.676, P=0.411].Fifty-seven patients were followed up for 1 -85 months(median,39 months), without long-term complications occurred. Conclusion Ureteroscopy combined with ultrasonic pneumatic lithotripsy is safe and effective for the treatment of complicated ureteral calculi, having advantages of shorter operation time and higher efficiency.
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