急诊输尿管镜气压弹道碎石与体外冲击波碎石治疗输尿管结石并急性肾绞痛比较研究

Comparison of emergency ureteroscopic lithotripsy and extracorporeal shock wave lithotripay in the treatment of ureteral stones with acute renal colic

目的比较急诊输尿管镜气压弹道碎石与体外冲击波碎石治疗输尿管结石并急性肾绞痛的疗效。方法将输尿管结石并急性肾绞痛患者根据医生对患者自身状况及其临床病情评估结果,并结合患者的意愿选择体外冲击波碎石术,或输尿管镜气压弹道碎石术。对两组患者在碎石成功率、疼痛缓解情况、结石清除率及并发症发生率进行比较分析。结果输尿管镜气压弹道碎石术组患者的术后疼痛缓解率、碎石成功率、术后2周结石排净率3项指标均显著高于体外冲击波碎石术组,两组比较差异有统计学意义(P<0.05或P<0.01)。输尿管镜气压弹道碎石术组并发症发生率为5.00%,体外冲击波碎石术组并发症发生率为3.33%,差异无统计学意义(P>0.05)。对结石部位进行区组分析,位于输尿管上段者,输尿管镜气压弹道碎石术组术后疼痛缓解率为93.75%,显著高于体外冲击波碎石术组(P<0.05);碎石成功率及术后2周结石排净率、并发症发生率比较,两组差异均无统计学意义(P>0.05)。位于输尿管中下段者,输尿管镜气压弹道碎石术组术后疼痛缓解率、碎石成功率、术后2周结石排净率与体外冲击波碎石术组比较,差异均有统计学意义(P<0.05)。结论急诊输尿管镜气压弹道碎石治疗输尿管结合并急性肾绞痛,安全有效、术后结石排净率高,但需严格手术适应证。术中操作谨慎可提高治疗的成功率。

Objective To compare emergency ureteroscopic lithotripsy and emergency extracorporeal shock wave lithotripsy in the treatment of ureteral stones with acute renal colic. Methods Make the patients choose the treatment of ESWL or URL based on the patients＇ status and the wishes. To compare the success rate of lithotripsy,pain release,clearance rate of stones and complication incidence of the two groups. Results The pain release rate,success rate and stone-free rate after two weeks of URL were higher than ESWL.The differences were statistically significant （P 〈 0.05 or P 〈 0.01）. The complication incidence of URL was 5.00 % ,while the ESWL was 3.33 % .The differences were not statistically significant （P 〉 0.05）. To analyze the stones in different position between two groups.The pain release rate of URL was higher than ESWL for upper ureteral stones（P 〈 0.05）.Success rate,stone-free rate after two weeks and complication incidence rate were not statistically significant between two groups（P 〉 0.05）. The pain release rate,success rate and stone- free rate after two weeks between two groups were statistically significant （P 〈 0.05）. Conclusion The URL is effective and safe for the treatment of ureteral stones with acute renal colic.The postoperative stone-free rate was high, but strict surgical indications is needed.Operations in surgery should be prudent to improve the success rate of treatment.