两种术式治疗228例输尿管结石的临床对照分析

Clinical comparative analysis of holmium laser lithotripsy and pneumatic lithotripsy under ureteroscope treatment of 228 cases of ureteral calculi

目的探讨经输尿管镜钬激光碎石和气压弹道碎石治疗输尿管结石的临床效果和安全性。方法选择2008年1月至2013年12月我院泌尿外科收治的输尿管结石患者228例,采用双盲法将其分为对照组和观察组,每组均为114例。分别采用输尿管镜下气压弹道碎石(PL)和输尿管镜下钬激光(HL)治疗输尿管结石。两组的碎石成功率、结石排净率、手术时间、结石排净时间、疼痛消失时间、住院时间、住院费用及并发症发生率等疗效指标。结果观察组一次性碎石总成功率达到98.25%,显著高于对照组91.23%(P<0.05);手术时间、疼痛消失时间和住院时间均显著短于对照组(P<0.05),住院费用显著少于对照组(P<0.05);治疗1、2、3、4周后结石清除率均显著高于对照组(P<0.05);总并发症率7.89%,显著低于对照组13.16%(P<0.05)。结论输尿管镜下钬激光碎石术治疗输尿管结石效果好、费用低、痛苦少、恢复快、并发症少,综合疗效优于气压弹道碎石。

Objective To evaluate the clinical effect and the safety of holmium laser lithotripsy and pneumatic lith otripsy under ureteroscope in the treatment of ureteral calculi. Methods 228 patients with ureteral calculi were divided into control group and observation group with double blind method and 114 cases in each group. The ureteroscopic pneumatic lithotripsy （PL） and ureteroscopie holmium laser lithotripsy （HL） were used to treat ureteral calculi respectively. The success rate of lithotripsy, stone clearance rate, operation time, the lithagogue time, pain disappearing time, hospitalization time, cost of hospitalization and complication rate of therapeutic effect index of two groups were compared. Results The one-time success rate of lithotripsy in the observations groups were 98.25 %, significantly higher than that of the control groups 91.23% （P〈0.05）. The time of pain, operation and hospital stay were all significantly shorter than those of the control groups （P〈0.05） while the hospital costs was significantly less than that of the control groups （P〈0.05）. The stone clearance rate in the observations after 1, 2, 3, 4 weeks treatment were all higher than those of the control groups （P〈0.05） while the total complication rate was 7.89%, significantly lower than that of the control groups 13.16% （P〈0.05）. Conclusion The effect of holmium laser lithotripsy for ureteral calculi under ureteroscope was good and had a low cost, less pain, rapid recovery, few complications, curative effect was better than the pneumatic lithotripsy.