输尿管软硬镜结合钬激光碎石治疗较大肾及输尿管上段结石

Efficacy of Combination of Flexible and Rigid Ureteroscopic Ho-YAG Laser Lithotripsy in Treatment of Upper Urinary Tract Calculi Greater than 2cm

目的观察输尿管软硬镜结合治疗输尿管上段及肾盂直径2 cm以上结石的临床疗效.方法选取输尿管上段及肾盂结石患者41例,结石直径2~3.2 cm,平均直径2.6 cm.其中21例接受输尿管软硬镜结合治疗,其余20例接受单纯软镜治疗.结果软硬镜结合组平均手术时间96 min,单用软镜组平均手术时间144min,2组间差异有统计学意义(P<0.01);软硬镜结合组单次碎石成功13例,8例有较大残留结石者术后行ESWL术治疗后结石清除6例,最终手术成功率90%.单用软镜组单次碎石成功8例,12例有较大残留结石者术后行ESWL术治疗后结石清除4例,最终手术成功率60%,差异有统计学意义(P<0.05).2组均无严重并发症发生.结论与单纯使用输尿管软镜相比,输尿管软硬镜结合治疗输尿管上段及肾盂直径2 cm以上结石具有手术时间短、结石清除效果好的特点,配合ESWL则可取的更佳的疗效,但选择适当的患者接受手术对手术成功有重要意义.

Objective To observe the clinical result of treating upper urinary tract calculi greater than 2cm with combining flexible and rigid ureteroscopic Ho： YAG laser lithotripsy under the help of ESWL. Methods Forty patients with upper urinary tract calculi greater than 2 cm were observed, the diameter of the calculi of them was between 2 cm and 3.2 cm, and the average value was 2.6 cm. Twenty-one patients were treated by combining flexible and rigid ureteroscopic Ho： YAG laser lithotripsy, others were treated by flexible ureteroscopic Ho： YAG laser lithotripsy only, and ESWL was performed after the operation for some big remains. Results The average operative time of combining flexible and rigid ureteroscopic group was 96 minutes, and that of the other group was 144 minutes, the difference of operative time between these 2 groups was significant （P 〈0.05）. In combining flexible and rigid ureteroscopic group 13 patients got a successful lithotripsy in the operation, 6 patients with big remains got a successful ESWL after the operation, the total success rate of this group was 90% ; to the other group, 8 patients got a successful lithotripsy in the operation, 4 patients with big remains got a successful ESWL after the operation, the total success rate of this group was 60%, the difference was significant （P〈0.05）. No serious complications occurred in both groups. Conclusion Compared with the flexible ureteroscopic Ho： YAG laser lithotripsy, combining flexible and rigid ureteroscopic Ho： YAG laser lithotripsy can get a better result for shorter operative time, higher success rate, in treatment of upper urinary tract calculi greater than 2 cm, and the help of ESWL will make the results better. However, careful chosen of patients is important for a good result.