钬激光碎石术与体外冲击波碎石术治疗输尿管下段结石疗效比较

Comparison between ureteroscopy with holmium: YAG laser lithotripsy and extracorporeal shock wave lithotripsy for lower ureter stones

目的:比较输尿管镜钬激光碎石术与体外冲击波碎石术(ESWL)治疗输尿管下段结石的有效性和安全性。方法:采用输尿管镜钬激光碎石术与体外冲击波碎石术治疗输尿管下段结石510例共534侧,比较两组手术时间、结石排净率、并发症发生率的差异。结果:对直径≥1cm和<1cm的输尿管结石钬激光碎石术治疗平均手术时间分别为50min和38min,短于ESWL的平均手术时间67min和55min(P<0.01);钬激光碎石术对直径≥1cm的输尿管结石3个月结石排净率为98.2%,高于ESWL的79.4%(P<0.01);对直径<1cm的输尿管结石钬激光碎石术和ESWL的3个月结石排净率分别为100%和95.1%(P>0.05)。钬激光碎石术组并发症发生率为3.2%(8/250)。结论:输尿管镜钬激光碎石术治疗直径≥1cm的输尿管下段结石,特别是合并有输尿管息肉和狭窄时疗效明显优于ESWL,而直径<1cm的结石二者疗效差异无显著性,ESWL为直径<1cm结石的首选治疗方法。

Objective： To compare the safety and efficacy of ureteroscopy with holmium：YAG laser lithotrpsy and extracorporeal shock wave lithotripsy（ESWL） for the lower ureter stones. Methods： 510 patients （534 sides） underwent ureteroscopy with holmium： YAG laser and ESWL. The operation time, stone-free rate and incidence rate of complications were compared between the two groups. Results ： The mean operation time of ureteroscopy with holmium：YAG laser lithotripsy for stone 1 cm or greater and less than 1 cm was 50 min and 38 min, respectively, which were shorter than 67 min and 55 min with ESWL（both P〈0. 01）. The stone-free rate after 3 months in patients with 1 cm or greater stone was 98. 2% for ureteroscopy with holmium： YAG laser lithotripsy. It was higher than 79： 4% with ESWL （P〈0. 01）. As for stone less than 1 cm, the stone-free rate with holmium： YAG laser lithotripsy and ESWL were 100% and 95. 1%, respectively（P〉0. 05）. The complication rate was 3.2%（8/250） in the group of ureteroscopy with holmium： YAG laser lithotripsy, while in ESWL group no complication occurred. Conclusions： ureteroscopy with holmium： YAG laser lithotripsy for the lower ureter stone 1 cm or greater in diameter, especially complicated with polyps or stricture,is more effective than ESWL, but no difference between the two groups for stone tess than 1 cm. ESWL can be used as the first-line therapy for stone less than 1 cm in diameter.