输尿管封堵器在输尿管镜碎石术治疗输尿管上段结石中的应用

Use of Ureteral Occlusion Device in Ureteroscopic Pneumatic Lithotripsy for Upper Ureteral Calculi

目的观察输尿管封堵器在输尿管镜碎石术处理输尿管上段结石中对预防结石移位的作用。方法 134例输尿管上段结石患者分为四组。A组（非梗阻性结石,不使用封堵器）,41例,结石平均表面积123（71~170）mm^2;B组（非梗阻性结石,使用封堵器）,31例,结石平均表面积119（71~181）mm^2;C组（梗阻性结石,不使用封堵器）,29例,结石平均表面积131（71~207）mm^2,结石梗阻时间8.6（2~32）个月;D组（梗阻性结石,使用封堵器）,33例,结石平均表面积129（71~196）mm^2,结石梗阻时间9.5（2~35）个月。观察四组的平均住院天数、平均手术时间、术中出血量、手术前后血肌酐的升高值、结石残留率和术后并发症发生率的差异。结果四组的平均住院天数、平均手术时间、手术出血量、手术前后血肌酐的升高值和术后并发症发生率差异无统计学意义（P〉0.05）。A组与C组的结石残留率差异无统计学意义（P〉0.05）。B组的结石残留率明显比A组小,差异有统计学意义（P〈0.01）。C组与D组的结石残留率差异无统计学意义（P〉0.05）。B＋D组的结石残留率比A＋C组小,差异有统计学意义（P〈0.05）。结论输尿管封堵器在不增加手术的难度、不增加并发症的情况下,可以减少结石移位的发生率,特别是在非嵌顿性输尿管结石,但是在嵌顿性输尿管结石差别不大。

Objective To evaluate the efficacy and safety of ureteral stone occlusion device in preventing retropulsion of upper ureteral calculi during ureteroscopic pneumatic lithotripsy. Methods 134 patients with upper ureteral calculi wene divided into four groups. Group A consisted of 41 patients with non impacted upper ureteral calculi not using ureteral occlusion device,the auerage surface aned of calculi is 123（ 71 ~ 170） mm^2. Group B consisted of 31 patients non impacted upper ureteral calculi using ureteral occlusion device,the average surface area of calculi is 119（ 71 ~ 181） mm^2. Group C consisted of 29 patients with impacted upper ureteral calculi not using ureteral occlusion device,the average surface area of calculi is 131（ 71 ~ 207） mm^2. Group D consisted of 33 patients with impacted upper ureteral calculi using ureteral occlusion device,the average surface area of calculi is129（ 171 ~ 196） mm^2. All patients underwent ureteroscopic pneumatic lithotripsy and operational parameters were compared in between the four groups. Results There were no differences in hospital stay,operation time,amount of bleeding in operation,difference of preoperative and postoperative serum creatinine,serious complications between the four groups（ P〉0. 05）. There were no differences in the rate of residual stone between group A and group C（ P〉0. 05）. There was a statistically significant in the rate of residual stone between group A and group B（ P〈0. 01）. There were no differences in the rate of residual stone between group C and group D（ P〉0. 05）. There was a statistically significant in the rate of residual stone between group A＋C and group B＋D（ P〈0. 01）. Conclusion Use of ureteral occlusion device in ureteroscopic pneumatic lithotripsy for upper ureteral calculi does not increase the operation difficulty,not increase complications; can reduce retropulsion of stones,particularly in non impacted upper ureteral calculi,but no difference in mpacted upper ureteral calculi.