影响输尿管镜钬激光碎石效果的相关因素分析

Analysis of the correlated factors associated with the efficacy of ureteroscopic Holmium laser lithotripsy

目的探寻与输尿管镜钬激光碎石(URL)术中并发症发生率和碎石成功率相关的影响因素。方法对382例输尿管结石行输尿管镜钬激光碎石手术。分析这些患者的性别、年龄、结石大小、位置、嵌顿与否、手术成功率、术中并发症率和术者行URL的经验。依据术者所做URL数量多少,将术者分成4个经验组。结果总体碎石成功率91.9%,22例(5.76%)出现并发症。最有经验组与较少经验组成功率分别为94.7%和77.8%(P<0.001),并发症率分别为3.2%和22.2%(P<0.001)。嵌顿结石组与非嵌顿结石组成功率分别为79.5%和94.8%(P<0.001),并发症率分别为16.4%和3.2%(P<0.001)。性别、年龄、结石位置和大小与碎石成功率及并发症率无显著相关(P>0.05)。结论与输尿管镜钬激光碎石治疗输尿管结石的碎石成功率和并发症率相关的因素是术者的经验及结石嵌顿与否。非嵌顿结石和有经验的术者碎石成功率高,且发生并发症少。性别、年龄、结石位置和大小与碎石成功率、并发症率无显著相关。

【Objective】 To define correlated factors for success and complications for ureteroscopic holmium laser lithotripsy procedures.【Methods】 All 382 ureteroscopic holmium laser lithotripsy procedures were performed for ureteral calculi between 2007 and 2008.Data recorded of sex,age,stone size,stone location,impacted stone,success rate,complications and surgeon experience for this procedure were analyzed.Surgeon experience was divided into four groups based on the number of procedures performed.【Results】 Total success rate was 91.9%.Complications were present in 22 patients（5.76%）.Success rate was significantly（P 0.001） related to surgeon experience,with 94.7% success in the most experienced group and 77.8% in the less experienced group and Complication rate were 3.2% versus 22.2%（P 0.001）.Furthermore,Success rate for impacted versus nonimpacted were 79.5% versus 94.8%（P 0.001） and Complication rate were 16.4% versus 3.2%（P 0.001）.Sex,age,stone location and size did not significantly influence complication and success rates.【Conclusion】 Surgeon experience and impaction of stone are correlated factors for success and complications for ureteroscopic holmium laser lithotripsy for ureteral calculi.Nonimpacted stone and experienced surgeons have fewer complications and higher success rate.Sex,age,stone location and size were not significantly related to complication or success rates.