拦石网在输尿管上段结石微创治疗中的临床研究

A clinical study of ureteroscopic lithotripsy with intercept stone network for the treatment of upper ureteral stones

目的:比较输尿管镜碎石术,输尿管镜联合拦石网碎石术及经皮肾镜碎石术治疗输尿管上段结石的疗效,探讨输尿管镜联合拦石网碎石术的临床价值。方法:分析236例输尿管上段结石微创治疗的临床资料,其中79例采用硬性输尿管镜碎石术(Ureteroscopic lithotripsy,URL)治疗,88例采用硬性输尿管镜联合拦石网碎石术(URL+拦石网)治疗,69例采用经皮肾镜碎石术(Percutaneous nephrolithotomy,PCNL)进行治疗。结果:URL+拦石网组一次性碎石成功率97.7%(86/88)与URL组83.5%(66/79)比较差异有统计学意义(P<0.05),与PCNL组98.5%(68/69)比较差异无统计学意义(P>0.05);URL+拦石网组并发症发生率6.8%(6/88)与URL组6.3%(5/79)比较差异无统计学意义(P>0.05),与PCNL组7.2%(5/69)比较差异无统计学意义(P>0.05);URL+拦石网组手术时间(38.53±11.96)min与URL组(36.47±10.87)min比较差异无统计学意义(P>0.05),与PCNL组(40.17±10.96)min比较差异无统计学意义(P>0.05);URL+拦石网组住院时间(3.58±1.96)d与URL组(3.49±1.79)d比较差异无统计学意义(P>0.05),与PCNL组(8.62±1.84)d比较差异有统计学意义(P<0.05)。结论:输尿管镜联合使用拦石网可明显提高输尿管上段结石的碎石成功率,与经皮肾镜碎石取石术比较同样安全有效。

Objective：To investigate the effect of ureteroscopic lithotripsy with intercept stone network for the treatment of upper ureteral stones.Methods：236 patients with upper ureteral calculi were randomly divided into three groups.79 cases were treated by rigid ureteroscope lithotripsy,while 88 cases were treated by rigid ureteroscopic lithotripsy with intercept stone network but another 69 cases underwent percutaneous nephrolithotomy.Results：The success rate of primary lithotripsy in ureteroscopic lithotripsy with intercept stone network group was 97.7% and higher than that in ureteroscopic lithotripsy without intercept stone network group which was 83.5%（P0.05）,but there was no significant difference compared with percutaneous nephrolithotomy group（98.5%,P0.05）.There was no significant difference in the complication rate among the three groups（P0.05）,as well as operation time.The hospitalization time in ureteroscopic lithotripsy with intercept stone network group was（3.58±1.96） d,and was less than that in percutaneous nephrolithotomy group（8.62 d±1.84 d,P0.05）,but there was no significant difference compared with ureteroscopic lithotripsy without intercept stone network group（3.49 d±1.79 d,P0.05）.Conclusion：Holmium laser lithotripsy under ureteroscope combined with intercept stone network which fixes calculi and then breaks stone in the treatment of upper ureteral calculi can prevent the calculi from being pushed back or reversed,and then can obtain high a calculus fragmentation success rate as percutaneous nephrolithotomy.