肾绞痛发生后不同时间点行URL治疗输尿管中下段结石的疗效比较

Comparative study of URL therapy at different time points after renal colic in treatment of middle-lower ureteral calculi

目的探讨肾绞痛发生后不同时间点行经输尿管镜碎石术(URL)治疗输尿管中下段结石临床疗效差异。方法选择蚌埠市第三人民医院2012年1月至2015年9月行URL治疗输尿管中下段结石患者共98例,依据肾绞痛首次发作后14 d内和14 d后行手术治疗分为A组(50例)和B组(48例),比较两组患者手术时间、术前尿常规和尿培养检测感染发生率、一次性结石清除率、输尿管息肉检出率及术后第14天双J管拔除率等。结果 B组患者手术时间(48.60±7.84)min显著长于A组(38.23±5.35)min,差异有统计学意义(P<0.05);B组患者术前尿常规检测感染发生率和输尿管息肉发生率显著高于A组(P<0.05);B组患者术后第14天双J管拔除率显著低于A组(P<0.05)。结论肾绞痛首次发作后14 d内行URL治疗输尿管中下段结石可有效缩短手术时间,减少术前尿路感染和输尿管息肉发生,并有助于缩短术后留置双J管时间。

Objective To investigate the differences of clinical efficacy of ureteroscopic lithotripsy( URL) at different time points after renal colic in the treatment of middle-lower ureteral calculi. Methods From Jan 2012 to Sep 2015,ninety-eight patients with middlelower ureteral calculi underwent URL therapy in our hospital,and according to the URL implementing period after their first episode of ureteric colic,they were divided into group A( 50 patients,within 14 days) and group B( 48 patients,more than 14 days). The operation time,preoperative infection incidence examined by urine analysis and urine culture,first-time stone clearance rate,occurrence rate of ureter polyp,and removal rate of double-J tube at 2 weeks after operation were compared between the two groups. Results The operation time of group B was significantly longer than that of group A( 48. 60 ± 7. 84 min vs 38. 23 ± 5. 35 min,P < 0. 05). The preoperative infection incidence tested by urine analysis and the occurrence rate of ureter polyp of group B were significantly higher than those of group A( P < 0. 05),but the removal rate of double-J tube of group B at 2 weeks after operation was significantly lower than that of group A( P < 0. 05). Conclusion Application of URL therapy in the treatment of middle-lower ureteral calculi within 14 days after first episode of renal colic could efficiently shorten operation time and indwelling time of double-J tube after operation,and reduce the occurrence of preoperative urine infection and ureter polyp.