联合应用钬激光及套石篮与单用钬激光在经尿道输尿管镜治疗输尿管上段结石的比较研究

摘要

目的 比较联合应用钬激光及套石篮与单用钬激光在经尿道输尿管镜治疗输尿管上段结石的疗效及安全性.方法 回顾性分析2007年6月～2010年9月经尿道输尿管镜治疗输尿管上段单发结石109例的临床资料,2009年1月前采用钬激光碎石(A组,51例),2009年1月后先置入WOLF套石篮套住结石,再用钬激光碎石(B组,58例).比较2组的手术时间、碎石成功率、输尿管穿孔、术后感染、术后3周结石排净率及术后输尿管狭窄率.结果 A组结石上移28例,B组结石上移3例,须二期手术,B组碎石成功率和3周结石排净率均明显高于A组[碎石成功率94.8%(55/58) vs.45.1%(23/51),χ2=32.976,P=0.000;3周结石排净率96.4%(53/55) vs.65.2%(15/23),χ2=11.428,P=0.001].A组输尿管穿孔率为B组的4.6倍[15.7%(8/51) vs.3.4%(2/58),χ2=3.520,P=0.061].B组平均手术时间比A组长8 min[(46±19) min vs.(38±13)min,t=2.530,P=0.013].2组术后感染率、输尿管狭窄率差异无显著性(P均=1.000).结论 在经尿道输尿管镜碎石治疗输尿管上段结石中联合应用钬激光及套石篮,疗效及安全性高于单用钬激光.%Objective To compare the efficacy and safety of holmium laser combined with stone basket and holmium laser alone in ureteroscopic lithotripsy for the treatment of upper ureteral calculi. Methods The clinical data of 51 cases of single-use holmium laser (group A, between June 2007 and January 2009) and 58 cases of holmium laser combined with WOLF stone basket ( group B, between January 2009 and September 2010) were retrospectively analyzed in this study. The operation time, success rate of lithotripsy, and the rates of ureter perforation, postoperative infection and construction, and clearance of calculus in 3 weeks were compared between the two groups. Results Group B showed significantly higher success rate of lithotripsy [94.8％ (55/58) vs.45.1％ (23/51 ), x2 = 32. 976, P = 0. 000 ], lower ureter perforation rate [ 3.4％ (2/58) vs. 15.7 ％ ( 8/51 ), 1: 4.6, x2 = 3. 520,P=0.061], higher clearance rate of calculus in 3 weeks [96.4％ (53/55) vs. 65.2％ (15/23),x2 =11.428,P=0.001], and longer operation time [ (46 ± 19) min vs. (38 ± 13) min, 8 min longer in average, t =2.530, P =0.013] than group A. Totally 31 cases (28 in group A and 3 in group B) received a second operation because of upward migration of the calculi. No significant difference was detected in the rates of postoperative infection and construction rate between the two groups ( both P = 1. 000).Conclusion Holmiumlaser combined with stone basket is more effective and safe than single-use holmium laser for treatment of upper ureteral calculi in ureteroscopic lithotripsy.