目的 观察术前使用利尿剂配合输尿管镜气压弹道碎石术治疗输尿管结石的临床效果.方法 将2007 年12月至2010年2月术前使用呋塞米40 mg配合输尿管镜气压弹道碎石术治疗输尿管结石542例患者与2006 年5月至2007年11月单用输尿管镜气压弹道碎石术治疗输尿管结石287例患者进行比较.入院时照第1张X光腹部片,术前照第2张,术后再照第3张.前两片比较,结石移动一个锥体以上认为结石有移动,否则为无移动.第3张片用来比较两组的碎石效果.结果 结石移动率:实验组542例,结石移动108例,其中,上段结石由152 例(28%)下降到98例(18%),中段结石由114例(21%)上升到124例(23%),下段结石由276例(51%)上升到320例(59%);对照组287例,结石移动3例(1%),其中,上段结石由89例 (31%)下降到86例(30%),中段结石由43例(15%)上升到46例(16%),下段结石无变化;两组术前结石移动率比较,差异有统计学意义(P＜0.05).碎石有效率:实验组542例中无残石504例,碎石有效率为93%,有残石38例,无效率为7%;对照组287例中无残石192例,碎石有效率为67%,有残石95例,无效率为33%;两组碎石有效率比较差异有统计学意义(P＜0.05).结论 利尿剂配合输尿管镜气压弹道碎石术可促使结石术前向输尿管远端移动,有利于结石破碎和排出,提高了碎石成功率和残石排净率,是较好治疗输尿管结石的方法之一.%Objective To study the clinical effect of the ureterscope barometric pressure trajectory lithotrity treating the ureterolithiasis cooperating with the diuretics before the operation. Methods Compared 542 samples who receivied the ureterolithiasis treatment under the ureterscope barometric pressure trajectory lithotrity cooperating with furosemide 40 mg from December 2007 to February 2010 to 287 examples who received the urete. Olithiasis treatment only under the ureterscope barometric pressure trajectory lithotrity from May 2006 to November 2007. Entering hospital took the first abdomen X-rays, then took the second before the operation, took the third after the operation. Comparing with the first two X-rays,if the stones moved more than one cone, the examples belonged to the moves,otherwise for non-moves. The third X-rays used to compare two group of crushed stone effects. Results Stone mobility: Experimental group: there were 108 moves in 542 examples, thereinto, upside ureter stones dropped from 152 (28％) examples to 98( 18％ ) examples, the center-section ureter stones turned 124(23％ ) examples from 114(21 ％ ) examples,the lower segment ureter stones rose from 276(51％ ) examples to 320(59％ ) examples. Control group: there were 3( 1％ ) moves examples in 287 examples, thereinto, the upside ureter stones dropped from 89 (31 ％ ) cxamples to 86 (30 ％ ) examples, the center-section ureter stones rose from 43 (15 ％ ) examples to 46 (16 ％ ) examples, the lower segment ureter stoncs did not change. Comparising the stone mobility of the two groups, the difference had the significance ( P＞ 0.05 ). Crushcd stone effectiveness: Experimental group: 542 examples, no-remnant stone 504 examples, crushed stone effectiveness was 93 ％, the remnant stone 38 examples, the inefficiency was 7 ％. Control group:no-remnant stone 192 examples,crushed stone effectiveness was 67％, the remnant stone 95 examples,the inefficiency was 33 ％. Comparising the crushed stone effectiveness of the two groups, the difference had the significance(P＜0.05). Conclusion Cooperating with the diuretics, ureterscope barometric pressure trajectory lithotrity could help the stones to move to the far-end ureter before operation,help the stones to break and discharge,and rise the crushed stone successful ratio and remnant stone removed cleanly ratio. The ureterscope barometric pressure trajectory lithotrity cooperating with the diuretics is one of good treatment of the ureterolithiasis.
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