双频双脉冲激光碎石术与钬激光碎石术治疗输尿管结石的比较

Comparison of the frequency-doubled double-pulse neodynium:YAG and holmium:YAG lasers lithotripsy for treatment of ureteral stones

目的:评价双频双脉冲激光与钬激光碎石术治疗输尿管结石的临床疗效。方法:应用输尿管镜技术治疗870例输尿管结石患者,双频激光碎石术治疗312例(输尿管上段结石52例,中下段输尿管结石260例);以钬激光碎石术治疗558例(输尿管上段结石92例,中下段输尿管结石466例),进行疗效比较。结果:双频激光和钬激光结石总体清除率分别为92.6%(289/312)和98.4%(549/558)(P>0.05);中、下段输尿管结石上移率分别为4.2%(11/260)和1.9%(9/466);手术平均碎石时间,双频激光组为(39.8±5.4)min,钬激光组为(26.5±7.2)min(P<0.01);平均结石排净时间为(29.2±6.8)d和(18.5±4.4)d(P<0.01);钬激光组发生输尿管穿孔5例,双频激光组无穿孔发生。结论:双频激光碎石术及钬激光碎石术均为有效的碎石方法;在平均碎石时间、结石排净时间方面钬激光碎石术具有优势;双频激光碎石术在安全性方面具有优势。

Objective： To compare clinical effective and complication rates of frequency-doubled double-pulse （FREDDY）and holmium laser lithotripsy for treatment of ureteral stones. Method： Eight hundred and seventy pa tients underwent ureteroscope lithotripsy either with FREDDY laser lithotripter（52 cases of proximal ureter calculi and 260 cases of middle distal ureter calculi among 312cases）or with holmium laser lithotripter（92 cases of proxi- mal ureter calculi and 466 cases of middle distal ureter among 558cases）for the treatment of ureteral stones. Result： The rate of stone-free cases was 92.6%（289/312）and 98.4%（549/558） （P〉0.05） ;The rate of stone retropulsion to renal pelvis 4.2 % （11/260）in FREDDY laser group and 1.9 % （9/.466）holmium laser group. The average litho- tripsy time of FREDDY laser and holmium laser were（39.8±5.4）min and（26.5±7.2）min（P〈0.01）. The aver- age stone-free time of FREDDY laser and holmium laser were（29.2±6.8）days and（18.5±4.4）days（P〈0. 01）. 5 perforations were encountered in holmium laser group whereas no perforation in FREDDY laser group. Conclusion： Endoscopic FREDDY laser and holmium laser lithotripsy are all effective treatment modality for ureteral stones. Holmium laser lithotripsy has its advantage over FREDDY laser lithotripsy in the average lithotripsy time and the average stone-free time,Whereas,FREDDY laser lithotripsy has its advantage in the safety.