输尿管镜下钬激光联合Ntrap结石拦截网与单用钬激光治疗输尿管段结石疗效比较

Comparison between holmium laser combined with Ntrap stone extraction and single-use holmium laser in ureteroscopic lithotripsy for upper ureteral calculi

目的比较输尿管镜下Ntrap结石拦截网联合钬激光与单用钬激光治疗输尿管上段结石的疗效。方法选择2008年3月至2010年4月行输尿管镜下钬激光碎石的80例输尿管上段结石患者为A组,2010年4月至2012年12月行输尿管镜下Ntrap结石拦截网联合钬激光碎石的110例输尿管上段结石患者为B组。比较2组患者的手术时间、碎石成功率、输尿管穿孔率、术后感染率、术后1个月结石排净率及术后输尿管狭窄发生率。结果 A组患者结石上移26例,B组患者结石上移15例,需二期治疗,A组与B组的一次碎石成功率分别为67.5%和86.4%,差异有统计学意义(χ2=9.739,P=0.002)。术后1个月结石排净率A组与B组分别为63.0%与91.6%,差异有统计学意义(χ2=26.813,P=0.000)。平均手术时间A组与B组分别为(48.8±9.8)min和(38.0±7.8)min,差异有统计学意义(χ2=8.515,P=0.009)。2组患者术后输尿管穿孔率、输尿管狭窄率、感染率比较差异均无统计学意义(P>0.05)。结论 Ntrap结石拦截网可有效防止输尿管镜下钬激光碎石过程中的结石移位,与钬激光碎石系统联合应用治疗输尿管上段结石较单用钬激光碎石具有结石清除率高、安全性好,创伤小等特点。

Objective To compare the efficacy of hohnium laser combined with Ntrap stone extraction and holmium laser alone in ureteroscopic lithotripsy for the treatment of upper ureteral calculi. Methods The clinical data of 80 cases of single-use holmium laser from March 2008 to April 2010 as group A and 110 cases of holmium laser combined with Ntrap stone extraction from April 2010 to December 2012 as group B were retrospectively analyzed in this study. The success rate of lithotripsy, mean operating time, the rates of ureter perforation, postoperative infection and construction and clearance of calculi in one month were compared between the two group. Results Totally 41 cases（26 cases in group A and 15 cases in group B） received a second operation because of upward migration of the calculi. In group A and group B,success rate on one session were 67.5% and 86.4% which had significant difference （x^2 =9. 739,P = 0. 002）. Stone-free rate after one month was 63.0% and 91.6% in the two groups which had significant differenee（x^2 =26. 813 ,P =0. 000）. Treatment time was（48.8 ±9.8）min and（38.0 ±7.8）min in group A and group B respectively and had significant difference （x^2 = 8. 515 ,P = 0. 009）. No significant difference was detec- ted in the rates of ureter perforation, postoperative infection and construction between the two groups （P 〉 O. 05 ）. Conclusion Ntrap stone extraction can effectively prevent ureteral calculi from moving upward during ureteroscopic holmium laser lithotripsy. Combined with holmium laser lithotripsy,it is effective, safe and minimally invasive for upper ureteral calculi.