NTrap网篮在输尿管镜钬激光碎石术治疗输尿管上段结石中的应用研究

Clinical study on holmium laser combined with NTrap basket in ureteroscopic lithotripsy for upper ureteral calculi

目的:对比单独使用钬激光与配合钬激光使用NTrap网篮在输尿管镜碎石术治疗上段输尿管结石中的临床疗效。方法:诊断患有输尿管上段结石的患者共106例115侧,住院期间均采用输尿管镜下钬激光碎石术进行治疗。其中对照组70侧,观察组45侧,对照组在术中单独使用钬激光碎石,观察组在术中同时配合钬激光使用NTrap网篮。比较对照组和观察组术中结石上移率、手术成功率,术后1个月结石排净率及术中术后并发症的发生情况。结果:术中对照组和观察组结石上移率分别为24.29%(17/70)和6.67%(3/45),碎石成功率分别为80.00%(56/70)和95.56%(43/45),手术成功的两组术后1个月结石排净率分别为82.14%(46/56)和95.35%(41/43),两组术中结石上移率、手术成功率和术后结石排净率相比较差异有统计学意义(P<0.05)。对照组术中发生输尿管穿孔2侧,观察组发生输尿管穿孔1侧。术后对照组有2例患者出现严重血尿,观察组1例出现严重血尿。对照组与观察组术后各有4例患者出现发热。两组术中术后相关并发症的发生率相比较差异无统计学意义(P>0.05)。结论:在输尿管镜碎石术治疗输尿管上段结石时,使用NTrap网篮配合钬激光碎石可以显著降低结石的上移率,提高手术成功率和术后1个月结石排净率,是一种安全、有效的方法。

Objective：To compare the clinical efficacy of holmium laser alone and holmium laser combined with NTrap basket in ureteroscopic lithotripsy for the treatment of upper ureteral calculi. Method：The clinic data of 106 cases（115 sides） of upper ureteral calculi treated by ureteroscope with holmium laser lithotripsy were retrospec- tively analyzed. These cases were divided into two groups randomly., control group （70 sides） which didn＇t apply NTrap basket and observation group （ 45 sides） which applied NTrap basket . The rate of calculi transiocation, success rate of lithotripsy , clearance rate of calculus in 1 month, and the rates of complication were compared between the two groups. Result：In control group, the rates of calculi translocation was 24.29 % （17/70）and in obser- vation group, it was 6.67%（3/45）, the successful rates of lithotripsy were 80.00% （56/70）and 95. 56% （43/ 45）, The clearance rate of calculus in 1 month were 82.14% （46/56）and 95.35% （41/43）, the significant differ- ence was detected in the rates of calculi translocation＇ the successful rates of lithotripsy and the clearance rate of calculus in 1 month between the two groups（ P d0.05）. In control group , ureteral perforation was detected in 2 sides, and in observation group, it was 1. In control group, there were postoperative hemorrhage in 2 cases, and in observation group, it was 1. In control group, Hyperthermia after operation was seen in 4 patients and in observation group it is 4, too. No significant difference was detected in the rates of complication（ P 〉0.05）. Conclusion： NTrap basket combined with ureteroscopy and holmium laser lithotripsy for treatment of upper ureteral calcu- li could reduce the rate of calculi translocation. It can improve the successful rate of lithotripsy and the clearance rate of calculus in 1 month. It is very effective and safe for treatment of upper ureteral calculi in holmium laser ure- terolithotripsy.