经自然通道硬通道输尿管软硬镜结合钬激光碎石术在肾结石中的应用研究

Application of holmium laser lithotripsy kidney stones in the ureter through natural pathways hard tunnel microscopy and Flex

目的 探讨经自然通道硬通道输尿管软硬镜结合钬激光碎石术在肾结石中的应用.方法 随机选取2015年1月至2016年3月在本院收治的90例肾结石患者,并取得所有研究对象本人同意.根据随机分组法将90例患者分为两组,B组为参照组45例,其中男性占35例,女性占10例,年龄29～70岁,平均年龄（50.34 ±6.26）岁;结石位于左侧18例,右侧27例;肾盂结石22例,肾中、上盏结石15例,肾下盏结石8例.A组为研究组45例,其中男性占32例,女性占13例,年龄33 ～ 72岁,平均年龄（52.26 ±7.28）岁;左侧20例,右侧25例.肾盂结石20例,肾中、上盏结石18例,肾下盏结石7例.B组采用传统的输尿管软镜联合钬激光碎石疗法,A组采用硬通道输尿管软硬镜结合钬激光碎石疗法.结果 A组手术时间指标比B组显著缩短,差异有统计学意义（P=0.031）;A组出血量指标比B组显著降低,差异有统计学意义（P=0.005）;A组住院时间指标和B组相比,差异无统计学意义（P=0.081）;A组手术辅助体外冲击波碎石术（ESWL）指标显著优于B组,差异有统计学意义（P=0.024）.A组患者肾结石治疗效果显著优于B组,差异均有统计学意义（P＜0.05）.A组患者碎石术后不良反应和B组相比明显减少,差异均有统计学意义（P＜0.05）.结论 改进后的输尿管软硬镜结合钬激光碎石疗法临床效果显著,值得推广.

Objectives To explore the application of rigid combined flexible ureteroscope holmium laser lithotripsy with rigid natual access sheath for kidney stones.Methods From January 2015 to March 2016,90 patients with kidney stones who signed informed consent of patients in our hospital were randomly divided into two groups：study group（45 cases in group A）,32 of them were males and 13 were females,with a mean age of （52.26 ±7.28） years,control group（45 cases in group B）,35 of them were males and 10 were females,with a mean age of （50.34 ± 6.26） years.In the control group,18 were on the left,27 were on the right.Pelvic stones in 8 cases,the kidney,the calyx stones in 15 cases,22 cases of lower calyx stones were found.Of the study group of 45 patients,20 were on the left,25 were on the right.7 cases of renal pelvis stones,kidney,upper calyx calculi in 18 cases,25 cases of lower calyx stones were found.The patients in group B were treated with traditional flexible ureteroscope holmium laser therapy,and the patients in group A were treated with flexible ureteroscope holmium laser lithotripsy with rigid natual access sheath therapy.Results Operative time in group A significantly reduced than group B,the difference was statistically significant （P =0.031）.Bleeding index of group A was significantly lower than in group B,the difference was statistically significant （P =0.005）.There was not statistically significant difference in hospital stay between the two groups（P =0.081）.Adverse reactions after treatment in the group A were significantly reduced than in the group B （P 〈 0.05）.Conclusions Rigid combined flexible ureteroscope holmium laser lithotripsy with rigid natual access sheath is effect,worthy of clinical promotion and application.