输尿管镜下钬激光碎石术中3种灌注方法的效果比较

A comparative study of the effectiveness of three perfusion methods in ureteroscopic lithotripsy with holmium laser

目的探索输尿管镜下钬激光碎石术中较优的灌注方式。方法选择2014年1月至2016年4月进行输尿管镜下钬激光碎石治疗的96例患者作为研究对象，随机分为3组：Ⅰ组（32例）接受自然重力灌注冲洗，Ⅱ组（32例）接受灌注泵定压持续灌注冲洗，Ⅲ组（32例）接受人工手动加压灌注冲洗。比较3种灌注方式在手术视野清晰度、平均手术时间以及术中冲洗量的差异。结果3组患者手术视野清晰度、平均手术时间以及术中冲洗量的差异具有统计学意义；3组患者术后低热（37．3—38．0℃）、中等热（38．1～39．0℃）、高热（39．1～40．0℃）人数分别为：I组2例、2例和1例，Ⅱ组8例、5例和4例，Ⅲ组3例、1例和1例，组间差异均有统计学意义（P〈0．05）；3组术后严重。肾区痛者分别为3例、9例和2例，组间差异均有统计学意义（P〈0．05）。结论在行输尿管镜下钬激光碎石术时建议使用人工手动加压灌注冲洗，该冲洗方法不仅可以较大程度地保证手术视野清晰，而且缩短手术时间，提高安全性，对减少术后发热及肾区疼痛等并发症具有重要意义。

Objective To compare the effectiveness of three perfusion methods used in ureteroscopic lithotripsy with holmium laser. Methods A total of 96 patients receiving ureteroscopic lithotripsy with holmium laser from January 2014 to April 2016 were included. They were randomly divided into 3 groups （ n = 32 ） ： perfusion and rising through natural gravity （ Group Ⅰ ）, constantly pressured perfusion and rising through infusion pumps （ Group Ⅱ） and perfusion and rising through manual pressure （ Group Ⅲ）. These groups were compared for field vision, average operating time and the volume of rinsing water. Results Statistical difference were found as to field vision, average operating time and the volume of rinsing water among the three groups. After surgery, there were 2 patients in Group Ⅰ , 8 in Group Ⅱ and 3 in Group Ⅲ with a body temperature of 37.3℃ - 38.0℃ ; there were 2 patients in Group Ⅰ , 5 in Group Ⅱ and 1 in Group llI with a body temperature of 38. 1℃ -39.0℃ ; and there were 1 patients in Group Ⅰ , 4 in Group Ⅱ and 1 in Group Ⅲ with a body temperature of 39.1℃ - 40.0℃, which were significant different among the groups （P 〈0.05）. Serious renal pain was reported after surgery in 3 patients from Group Ⅰ , 9 from Group Ⅱ and 2 from Group Ⅲ, which were significant different among the groups （ P 〈 0.05 ）. Conclusions Perfusion and rising through manual pressure is suggested during ureteroscopy lithotripsy with holmium laser lithotripsy, which can not only greatly maintain field vision, but also reduce operation time and improve surgical safety, and reduce postoperative complications.