输尿管镜钬激光碎石术与体外冲击波碎石术治疗输尿管结石的临床比较

Comparison between ureteroscopy with holmium:YAG laser lithotripsy and extracorporeal shock-wave lithotripsy for ureteral calculi

目的：比较输尿管镜钬激光碎石术（LL）与体外冲击波碎石术（ESWL）治疗输尿管结石的临床疗效和安全性。方法：总结2008年1月～2012年9月于我院泌尿外科住院治疗的465例输尿管结石患者的临床资料，采用LL治疗输尿管结石196例，其中结石直径〉1．0cm者104例，≤1．0cm者92例；采用ESWL治疗269例，其中结石直径〉1．0C1TI者128例，≤1．0cm者141例。比较两者治疗输尿管结石的手术时间、术后3个月结石排净率及手术并发症发生率的差异。结果：LL组治疗结石直径〉1．0cm和≤1．0cm的平均手术时间均明显少于ESWL组相应的平均手术时间，差异有统计学意义（P〈O．01）；对直径〉1．0cm的输尿管结石，LL组术后3个月结石排净率为93．3％，明显高于ESWL组的69．5％，差异有统计学意义（P〈O．01）；而对于直径≤1．0cm的输尿管结石，LL组和ESWL组术后3个月结石排净率分别为91．3％和89．4％，差异无统计学意义（P〉0．05）。ESWL治疗上段结石的有效率为87．2％，明显高于中下段结石74．3％，差异有统计学意义（P〈O．01）；而LL组的有效率分别为92．0％和92．6％，差异无统计学意义（P〉0．05）。LL组并发症发生率为4．6％，ESWL组无明显并发症发生。结论：综合考虑，对直径≤1．0cm的输尿管结石，尤其是上段结石，推荐ESWL治疗；而对直径〉1crll的输尿管结石，尤其是中下段结石，建议首选输尿管镜钬激光碎石术。

Objective： To compare the safety and efficacy of ureteroscopy with holmium： YAG laser lithotripsy （LL） and extracorporeal shock-wave lithotripsy （ESWL） for ureteral calculi. Method.. The data of 465 patients from January 2008 to September 2012 were analyzed. Ureteroscopy with holmium.. YAG laser lithotripsies were taken in 196 patients including 104 cases with diameter of stones ≤ 1.0 cm and 92 cases with diameter of stones ≤1.0 cm. ESWL were taken in 269 patients including 128 cases with diameter of stones ≤ 1.0 cm and 141 cases with diameter of stones 41.0 cm. The operation time, stone-free rate and incidence rate of complications were compared between the two groups. Result： The mean operation time of LL group for stones ≤1.0 cm and ≤ 1.0 cm were shorter than those with ESWL （both P〈0.01）. The stone-free rate after three months in patints with stones ≤ 1. 0 cm was 93.30//00 for LL group. It was higher than 69.5% with ESWL （P〈（0.01）. For calculi ≤ 1.0 cm, the stone-free rate with LL and ESWL were 91.3% and 89.4%/00 respectively （P〉0.05）. The stone-free rate after three months were 92.0% and 92.60% in the proximal and middle-distal ureteral calculi respectively without significant difference （P〉0.05） in LL group. While in ESWL group were 87.2% and 74.3% respectively （P〈0.01）. The complication rate was 4.6~ in the group of LL, while in the ESWL group no complications occurred. Conclusion： All things taken into consideration, for calculi ≤1.0 cm in diameter especially for the proximal ure- teral calculi, ESWL is worth recommending. For calculi 〉1.0 cm in diameter especially for the middle-distal ure- teral calculi, ureteroscopy with holmium.. YAG laser lithotripsy is the best choice.