两种半硬性输尿管镜下钬激光治疗输尿管上段结石疗效分析

摘要

Objective To summarize the clinical effect and experience of two types of semirigid ureteroscopes in ureteroscopic lithotripsy (URS) by holmium laser for upper ureteral calculi.Methods The clinical data of 117 cases with upper ureteral calculi in our hospital from November 2012 to June 2016 were analyzed retrospectively.Of them,64 cases were defined as study group which received URS by Karl Storz ureteroscope 27010L (7/8.4 ～9.9 Fr),and the other 53 cases were defined as control group which by Karl Storz ureteroscope 27002L (8/9.5 ～ 12 Fr).The effect and complications were compared between the two groups.Results The total stone free rate (SFR) was 89.74％ (105/117).There was no statistical difference in operative time between two groups(P ＞ 0.05).Compare to the control group,the volume of rinse solution was less and the once time stone free rate was higher in study group and the differences were statistically (P ＜ 0.05).There were 3 cases failed in the study group including 2 of stone shifting into renal pelvis and 1 of ureteral twisting,and 9 cases failed in the control group including 5 of stone shifting,3 of unclear visual filed and 1 of ureteral twisting.No complication as fever,perforation and avulsion of ureter was found in the study group,but 2 cases of ureteral perforation,1 of ureteral avulsion and 3 of post-operative fever occurred in the control group.There was statistical difference in post-operative complication between two groups (P ＜ 0.05).Conclusion The thinner scope with independent irrigation channel and the channel opening on the ureteroscopic tip perpendicular to the surgical field is more suitable in the surgery of transurethral ureteroscopic holmium laser lithotripsy for upper ureteral calculi.%目的 分析总结两种半硬性输尿管镜下钬激光碎石治疗输尿管上段结石的疗效和经验.方法 回顾性分析2012年11月～2016年6月在我院行经尿道输尿管镜下钬激光碎石治疗的117例输尿管上段结石患者的临床资料,按碎石时选用的输尿管镜型号分为两组:研究组64例,采用27010L(7/8.4～ 9.9Fr)输尿管镜,对照组53例,采用27002L(8/9.5 ～ 12 Fr)的输尿管镜.比较两组治疗效果和并发症情况. 结果 两组患者共有105例患者一次性清除结石,总体结石清除率(SFR)为89.74％.两组手术时间比较,差异无统计学意义(P＞0.05).研究组术中冲洗液用量少于对照组,一次结石清除率高于对照组,差异均有统计学意义(P＜0.05).研究组手术失败3例,其中结石移位进入肾盂2例,输尿管扭曲无法到达结石部位1例;对照组失败9例,其中结石移位5例,术中视野不清3例,输尿管扭曲无法到达结石部位1例.研究组术后无一例发热、输尿管穿孔或撕脱等并发症;对照组术中输尿管穿孔2例,撕脱1例,术后发热(体温＞ 38.5℃)3例.两组并发症比较,差异有统计学意义(P＜0.05). 结论 经尿道半硬性输尿管镜下钬激光碎石处理输尿管上段结石宜选用较细的具有独立冲洗通道,且冲洗通道开口垂直于手术视野的输尿管镜.