双导管碎石仪联合Stone Cone治疗输尿管上段结石的疗效分析

Treatment of Upper Ureteral Stone with Ureteroscopy and CyberW and Dual Probe Lithotripter with Stone Cone

目的探讨双导管碎石仪联合泌尿系统取石网(Stone Cone,10 mm直径的芯心)治疗输尿管上段结石的疗效。方法选择2013年1月至2014年12月首都医科大学附属复兴医院收治的输尿管上段结石患者60例,依据随机数字表法分为联合组和对照组,各30例。联合组应用双导管碎石仪联合Stone Cone治疗,输尿管镜下将泌尿系统取石网(Stone Cone,10 mm直径的芯心)置于结石近端;对照组未联合Stone Cone治疗。比较两组患者的手术情况及随访情况。结果联合组中2例接近肾盂的结石在碎石过程中逆行进入肾盂,无法碎石,术后结合体外冲击波碎石术(EWSL)、体位排石进一步治疗。对照组1例因输尿管下段狭窄、扭曲,输尿管镜无法通过,放置D-J管,术后行ESWL治疗。联合组患者的一次治疗成功率89.3%(25/28),术后1个月结石清除率100.0%,对照组患者的一次治疗成功率41.4%(12/29),术后1个月结石清除率55.2%(16/29)。联合组患者的一次治疗成功率和术后1个月结石清除率高于对照组(P<0.05),两组治疗时间、出血量和并发症发生率比较差异无统计学意义(P>0.05)。结论采用双导管碎石仪联合Stone Cone治疗输尿管上段结石,快速、安全、治疗效果好,可有效防止结石移位,提高清石率,是一种可行的微创治疗方法。

Objective To evaluate the efficacy of ureteroseopy and Cyber Wand dual probe lithotripter with Stone Cone for treating upper ureteral calculi. Methods Total of 60 cases with Upper ureteral calculi admitted in Fuxing Hospital Affiliated to Captial Medical University from Jan. 2013 to Dec. 2014 were divided into two groups of combined group and control group,30 cases in each group according to random number table method. The combined group was applied double catheter lithotriptercombined with Stone Cone treatment under ureteroscope to approach urinary stone（ Stone Cone,10 mm diameter）; the control group was not given Stone Cone treatment. Operation and follow up of the two groups were compared. Results Two cases in the combined group had stone close to renal pelvis retrograding into renal pelvis during the lithotripsy,which received postoperative extracorporeal shock wave lithotripsy（ EWSL）,posture calculus discharging as further treatment. One case in the control group had ureter stricture and twist,which did not allow ureteroscope to get through,so D-J tube was placed,and postoperative ESWL treatment was given. One-time success rate 89. 3%（ 25 /28） and stone clearance rate 1 month later（ 100. 0%） of the combination group were higher than the control group’s 41. 4%（ 12 /29） and 55. 2%（ 16 /29）（ P 〈 0. 05）; the treatment time,the amount of bleeding and the incidence of complications of th etwo groups had no significant differences（ P 〉 0. 05）.Conclusion Using Stone Cone during the procedure of treating upper ureteral calculi with ureteroscopy and Cyber Wand Dual Probe Lithotripter could prevent the stone shifting effectively and increase the stone clearance,which is a safe,fast and effective treatment.