取石网篮与传统取石钳在输尿管镜碎石术中的对比研究

A comparison of stone extractor and traditional stone forceps applied in ureteroscopic lithotripsy

目的比较取石网篮与取石钳在输尿管镜治疗输尿管结石术中的取石效率及安全性。方法回顾性分析中山大学附属第三医院2015年7月至10月开展输尿管钬激光碎石取石术病例共45例,其中采用取石网篮取石22例作为研究组,以同一术者主刀的23例采用输尿管镜取石钳取石作为对照组,进行统计学分析,比较两种方法的取石效率、安全性等相关临床指标。结果取石网篮组和取石钳组的结石一次清除率分别为95.4%和86.9%(P>0.05),平均手术时间前者少于后者[(30±10)min vs(58±18)min,P<0.05],平均单次取石时间,前者远低于后者[(15.3±2.7)s vs(35.3±10.2)s,P<0.05],平均单次取石大小,结石长径前者大于后者[(6.2±1.3)mm vs(4.3±2.2)mm,P<0.05]。取石网篮组因取石输尿管以及尿道黏膜损伤者2例,取石钳组因钳夹结石引发上述轻微损伤者7例;出现已取得结石在尿道滑脱者,取石网篮组0例,取石钳组13例。结论在输尿管镜下钬激光碎石取石术中,采用取石网篮套取输尿管结石具有一定的优势,是一种安全有效的取石方法。

Objective To compare the stone-free rate and security of stone extractor and lithotomy forceps applied in the ureteroscopic lithotripsy. MethodsTotally 45 cases with ureteral stone underwent ureteroscopic lithotripsy in the Third Affiliated Hospital of Sun Yat-Sen University were enrolled in this study from July 2015 to October 2015, in which the stone extractor applied in 22 cases who were enrolled in the study group, and the traditional lithotomy forceps applied in 23 cases performed by the same surgeon as the control. The data were statistical analysis. The stone-free rate, complains and operation time of both group were analyzed. Results The operations were performed successfully in all cases, without any severe complications. In the extractor group and forceps group, the stone-free rate was 95.4% and 86.9% respectively （P〈0.05）, the mean operation time was （30±10） min and （58±18） min, and the mean fetching stone time was （15.3±2.7） s and （35.3±10.2）s （P〈0.05）, the mean size of fetched stones was （6.2±1.3） mm and （4.3±2.2） mm （P〈0.05）. Ureter and urethral mucosa injury occurred in 2 cases in the extractor group and 7 cases in the forceps group arisen from fetching stone. There Was no stone slipped from stone extractor, and 13 stones slipped from lithotomy forceps. Conchusions The stone extractor has obvious advantage and was safe in the ureteroscopic lithotripsy.