四种输尿管镜入镜方法的临床疗效比较

Comparison of the Effects between Four Methods for Ureteroscope to Enter the Ureter

目的探讨4种输尿管镜入镜方法的成功率及对输尿管口的损伤。方法回顾性分析2008年7月-2011年3月间行输尿管镜手术的患者共553例,按其入镜方法分为4组,分别采用球囊扩张法、灌注泵加压灌注入镜法、内旋法及倒入法进行输尿管镜操作。分析其成功率及对输尿管口的损伤。结果气囊扩张法成功率为95%,但对输尿管口的损伤率为100%;灌注泵加压法成功率为67.5%,输尿管口损伤率为87.0%;内旋法的成功率为87.9%,损伤率为50.0%;倒入法成功率91.0%,对输尿管口损伤率为22.2%。4种方法中,灌注泵加压法一次性成功率最低,与其余3种方法比较,差异均有统计学意义(P<0.008);其余3种方法间一次性成功率差异无统计学意义(P>0.008)。对输尿管口的损伤率,4种方法组间两两比较的差异均有统计学意义(P<0.008),其中气囊扩张法损伤率最高,倒入法最低。结论倒入法是4种方法中成功率较高且损伤小的一种方法。

Objective To analyze four methods for ureteroscope to enter the ureter, discuss their successful rate and assess their damages to the ureter. Methods From July 2008 to March 2011, we retrospectively analyzed the clinical data of 553 patients who had undergone ureteroscopy. Based on the methods of entering the ureter, they were divided into four groups, and the four methods were transluminal balloon dilatation, infusion pump pressing on the ureter, internal rotation method and inverted ureteroscope. The overall rate of success and their damages to the ureter were analyzed and compared. Results The one-time success rate of the transluminal balloon dilatation was 95%, while its ureter damage rate was 100%; the one-time success rate of infusion pump pressing method was 67.5% and the damage rate was 87%; the one-time success rate of internal rotation method was 87.9% and the damage rate was 50%; the one-time success rate of inverted ureteroscope method was 91% and the damage rate was 22.2%. In the four methods, the one-time success rate of the infusion pump pressing method was the lowest, and compared with other methods, the differences were statistically significant （P 〈 0.008）. There was no significant differences among the other three kinds of methods in terms of the one-time success rate （P 〉 0.008）. The damage rate of ureter was significantly different among the four groups （P 〈 0.008）, and the highest was transluminal balloon dilatation method and the lowest was inverted uteteroscope method. Conclusion Inverted ureteroscope to enter the ureter is the best method with higher success rate and the lowest damage rate.