一期与分期输尿管软镜治疗双侧上尿路结石的疗效比较

Same-session Bilateral Versus Staged Unilateral Flexible Ureteroscopic Lithotripsy for Upper Urinary System Stones

目的探讨一期与分期输尿管软镜下碎石术（flexible ureteroscopic lithotripsy,FURL）治疗双侧上尿路结石的临床疗效。方法我院2012年9月~2015年5月一期输尿管软镜下钬激光碎石术治疗双侧上尿路结石29例（一期手术组）,分期输尿管软镜治疗双侧上尿路结石20例（分期手术组）,比较2组总手术时间、总住院时间、结石清除率、并发症发生率。结果 2组患者均顺利完成手术。一期手术组总手术时间明显短于分期手术组[（71.0±19.0）min vs.（112.6±26.8）min,t=-6.366,P=0.000],2组总住院时间无统计学差异[（6.9±3.6）d vs.（8.4±2.1）d,t=-1.674,P=0.101]。2组患者术后4周结石清除率分别为79.3%（23/29）、80.0%（16/20）,无统计学差异（χ~2=0.000,P=1.000）;2组术后并发症发生率无统计学差异[20.7%（6/29）vs.15.0%（3/20）,χ~2=0.017,P=0.896]。结论一期双侧输尿管软镜钬激光碎石术可有效、安全治疗双侧上尿路结石,但仍需严格把握手术适应证。

Objective To analyze the efficacy and safety of same-session bilateral and staged unilateral flexible ureteroseopie lithotripsy （FURL） with holmium laser for the treatment of upper urinary system stones. Methods Clinical data of 29 patients who underwent same-session bilateral FURL （same-session group） and 20 patients who received staged unilateral FURL （staged group） from September 2012 to May 2015 at this hospital were analyzed retrospectively. The overall operation time, overall hospital stay, stone free rate （SFR） and overall complication rate were compared between the two groups. Results The operations were successfully completed in both groups. The overall operative time was significantly longer for staged unilateral FURL than bilateral FURL [ （71.0 ±19.0） rnin vs. （ 112.6 ±26.8） min, t = - 6. 366, P = 0. 000 ]. The overall hospital stay was slightly longer for staged unilateral FURL than bilateral FURL [（6.9±3.6） d vs. （8.4 ±2. 1 ）d, t = -1.674, P =0. 101]. The four-week postoperative SFR for bilateral FURL and staged unilateral FURL were 79.3% （23/29） and 80.0% （16/20）, respectively （X2 = 0. 000, P = 1. 000）. The 2 overall complication rate was slightly higher for bilateral FURL [20.7% （6/29） vs. 15.0% （3/20）, X = 0. 017, P = 0. 8961. Conclusion Same-session bilateral flexible ureteroseopie holmium laser lithotripsy is a safe and effective treatment for bilateral upper urinary system stones in select patients.