旁置4F输尿管导管注水灌洗配合输尿管镜钬激光碎石术治疗输尿管上段结石的临床疗效

Clinical effects of ureteroscopic holmium laser lithotripsy combined with paracalculous 4F ureteral catheter irrigation in treating upper urinary tract stone

目的探讨4F输尿管导管注水灌洗配合输尿管镜钬激光碎石术（URL）治疗输尿管上段结石的临床效果。方法回顾性分析2011年6月~2012年6月该院86例行URL输尿管上段结石患者的临床资料。随机分为两组：应用4F输尿管导管注水灌洗43例（A组）,43例输尿管结石患者在输尿管镜钬激光碎石术前先将4F输尿管导管插至结石上方留置,持续注水灌洗的同时进行钬激光碎石,未应用43例（B组）。比较两组患者的结石清除率、手术时间、手术并发症发生率、住院时间和住院费用。结果 A、B两组结石清除率分别为93.0%（40/43）和83.7%（36/43）,手术时间分别为（30±5）和（42±5）min,差异均有显著性（P〈0.05）。两组住院时间分别为（3.4±0.4）d和（3.3±0.5）d,并发症发生率分别为11.6%（5/43）和13.9%（6/43）,住院费用为（8 526±180）和（8 639±150）元,差异无显著性（P〉0.05）。结论 4F输尿管导管注水灌洗配合输尿管镜钬激光碎石术治疗输尿管上段结石,手术视野更清晰,结石不易上移,疗效安全确切,操作简单、方便,能有效提高结石清除率,缩短手术时间,不增加手术并发症,具有良好的临床应用价值。

[Objective ] To investigate the clinical effects of ureteroscopic holmium laser lithotripsy with com- bined 41 ureteral catheter irrigation in treating upper urinary tract stones. [Methods ] Clinical data of 86 cases with upper urinary tract stone in our hospital from June 2011 to June 2012 underwent ureteroscopic Ho： YAG laser lithotripsy were analyzed retrospectively. 86 patients were divided into two groups randomly.43 patients received ureteroscopic hohnium laser lithotripsy combined with paracaleulous 4 F ureteral catheter above the stones irrigation in treating upper urinary tract stone （group A）, the other without paracaleulous 4 F ureteral catheter irrigation （group B）. Comparison of two groups of patients were stone-free rates, operation time, operation complication rate, hospital stay and eost of hospitalization. [ Results ] Stone-free rates, operation time, operation complication rate, hospital stay and cost of hospitalization for group A and B patients were 93. 0% （ 40/43）/ 83. 7% （36/43）, （30 ±5） min/（42±5） min, （3.4± 0.4）d/（3.3±0.5）d, 1 1. 6% （5/43）/13.9% （6/43） and （8526 ±180）/（8639±150）, respectively. The differences between stone-free rates and operation time were statistically significant （P 〈0.05）. However, operation complication rate, hospital stay and cost of hospitalization had no significant difference between group A and B （P 〉0.05）. [ Con clusion ] Ureteroscopic Ho：YAG laser lithotripsy with ureteral catheter irrigation leads to better visibility of the surgi- cal field, prevents the calculus from moving upward, and delivers substantial effects and safety. The operation is simple and convenient, can effectively improve the stone-free rate, shorten the operation time, does not increase the operation complications with good clinical application value.