输尿管镜术中保留斑马导丝对减少输尿管损伤的作用研究

摘要

Objective To investigate the effect of zebra guidewire preservation during ureteroscopy on reducing the occurrence of complications and to ensure a successful procedure.Methods 240 patients with ureteral calculi were randomly divided into study group and control group,120 for each group.The ureteroscope was guided by zebra guidewire to the ureter.In the study group as the ureteroscope arrived at stone site zebra guidewire across the stones and perservated in the ureter,exiting the ureteroscope and then insert it into the ureter again and use holmium laser to crush the stone,while in the control group as the ureteroscope arrived at the position of stones exiting the zebra guidewire and direct crushed the stones.The efficacy was observed in the two groups.The success rate of surgery,rate of stones shifted into the pelvis,rate of ureteral tract loss,and ureteral injury rate were analyzed and compared between the two groups.Results In the study group,120 patients were successful,with a rate of 100.0％;while in the control group,100patients were successful,with a rate of 83.3％,and with a significant difference(P＜0.05).In the study group with the upper section,14 shifted into the renal pelvis,with a rate of 25％,and with the middle and lower section,4 shifted into the renal pelvis,with a rate of 6.25％;in the control group with the upper section,24 shifted into the renal pelvis,with a rate of 48％,and with the middle and lower section,9 shifted into the renal pelvis,with a rate of 12.9％,and with a significant difference(P＜0.05).No ureteral tract loss occurred in the study group,while 15 developed ureteral tract loss in the control group,with a rate of 12.5％,and with a significant difference(P＜0.05).In the study group,4 patients developed ureteral injury,with a a rate of 3.3％,whereas 14 developed ureteral injury in the control group,with a rate of 11.7％,and with a significant difference(P＜0.05).Conclusions Zebra guidewire preservation in the ureter during ureteroscopy can reduce the complications and ensure successful procedures and made the surgery more safe and effective.%目的 探讨在输尿管镜手术中保留斑马导丝对减少手术并发症和保证手术顺利进行的作用.方法 将240例输尿管结石患者随机分为观察组及对照组,各120例,均在斑马导丝引导下进镜:其中观察组在输尿管镜到达结石部位后斑马导丝越过结石并保留于输尿管内,退镜后重新进镜至结石处并用钬激光碎石取石,术后留置双J管;对照组则在输尿管镜到达结石部位后退出斑马导丝,直接用钬激光碎石取石,术后留置双J管;术后3～5d复查腹部X线平片(KUB)和B超,观察两组疗效,对手术成功率、结石移入肾盂率、输尿管腔道丢失率和输尿管损伤率进行对比分析.结果 在手术成功率方面:观察组120例均取得成功,成功率100.0％(120/120);对照组100例取得成功,成功率83.3％(100/120);两组间差异具有统计学意义(P＜0.05).结石移入肾盂方面:观察组上段有14例移入肾盂,上移率25％(14/56),中下段4例移入肾盂,上移率6.25％(4/64);对照组上段24例移入肾盂,上移率48％(24/50),中下段9例移入肾盂,上移率12.9％(9/70);两组间差异具有统计学意义(P＜0.05).输尿管腔道丢失率方面:观察组无病例出现腔道丢失,腔道丢失率0.0％;对照组15例出现腔道丢失,腔道丢失率12.5％(15/120);两组间差异具有统计学意义(P＜0.05).输尿管损伤率方面:观察组4例发生输尿管损伤,损伤率3.3％(4/120);对照组14例发生输尿管损伤,损伤率11.7％(14/120);两组间差异具有统计学意义(P＜0.05).结论 在输尿管镜手术中保留斑马导丝能有效减少手术并发症和保证手术顺利进行,使手术更安全、有效.