钬激光与气压弹道碎石治疗上尿路结石合并急性肾功能不全的临床比较

Clinical Comparison Between Holmium Laser and Pneumatic Lithotripsy for the Treatment of Upper Urinary Calculi Complicated with Acute Renal Insufficiency

【目的】比较钬激光碎石术（Holmium：YAG laser lithotripsy，LL）和气压弹道碎石术（Pneumatic lithotripsy，PL）治疗上尿路结石合并急性肾功能不全的疗效及安全性。【方法1127例上尿路结石合并急性肾功能不全患者应用钬激光碎石治疗65例，气压弹道碎石治疗62例，对两种方法的疗效、安全性方面进行比较和评价。【结果】钬激光碎石组和气压弹道碎石组的结石一次粉碎率分别为83．08％和74．19％（P〈0．05）；平均手术时间前者（43．12±11．45）rain较后者短（53．31土14．18）min（P〈0．05）；平均术中出血量前者（34．39±12．36）mL较后者少（47．82土12．08）mL（P〈0．05）；平均住院时间前者（4．27±1．37）d较后者短（5．63土1．38）d（P〈0．05）；术后血尿素氮（BUN）和肌酐（CREA）恢复时间前者（6．93±3．22）d较后者短（8．32±3．24）d（P〈O．05）。随访1～3个月，无严重手术并发症。【结论】治疗上尿路结石合并肾功能不全钬激光较气压弹道碎石具有一定的优势，是一种安全有效的碎石方法。

[Objective] To compare the efficacy and safety of Holmium： YAG laser lithotripsy（LL） vs. pneumatic lithotripsy（PL） for the treatment of upper urinary calculi complicated with acute renal insufficiency. [Methods]Totally 127 cases of upper urinary calculi complicated with acute renal insufficiency underwent LL（ n = 65） or PL（ n = 62）, respectively. The efficacy and safety were compared between two groups. [Results] The rates of one-time fragmentation in LL group and PL group were 83.08%and 74.19%, respectively（ P 〈 0.05）. The average operation time of LL group was shorter than that of PL group[（43.12±11.45）rain vs. （53.31±14.18）min, P 〈0.05]. The average blood loss of LL group was less than that of PL group[（34.39±12.36）ml vs. （47.82±12.08）mL, P 〈0.05]. The average hospitalization time of LL group was shorter than that of PL group[（4.27±1.37）d vs. （5.63±1.38）d, P 〈0.05]. The recovery time of blood urea nitrogen（BUN） and creatine（CREA） after operation in LL group was shorter than that in PL group[,（6.93±3.22） d vs. （8. 32±3. 24）d, P 〈0. 05]. No severe complication occurred during 1 -3 months of follow-up. [Conclusion] Compared with PL, LL has more advantages in the treatment of upper urinary calculi. It is a safe and effective lithotripsy method.