“一步法”输尿管软镜治疗嵌顿性输尿管上段结石的临床分析

Clinical research on flexible ureteroscope ＂one step＂ treat impacted upper ureteric calculi

目的探讨＂一步法＂输尿管软镜治疗嵌顿性输尿管上段结石的安全性和有效性。方法回顾性分析2015年8月至2016年9月收治的80例嵌顿性输尿管上段结石患者的临床资料。其中采用＂一步法＂输尿管软镜碎石术（一步法组）40例，男22例，女18例；平均年龄（40.0±9.5）岁；结石最大径（1.8±0.5）cm；结石上方输尿管最宽处宽度（2.5±1.1）cm，结石CT值（1 089.0±111.3）HU。采用＂分步法＂碎石术（分步法组）40例，男21例，女19例；平均年龄（41.0±10.7）岁；结石最大径（1.7±0.6）cm；结石上方输尿管最宽处宽度（2.3±0.9）cm；结石CT值（1 002.0±97.2）HU。＂一步法＂即术中直接应用输尿管软镜碎石，结石返回肾盂后，软镜进镜至肾盂继续碎石。＂分步法＂即先使用输尿管硬镜碎石，结石返回肾盂后，更换输尿管软镜碎石。比较两组的手术时间、术后2周结石清除率及术后发热发生率。结果一步法组手术时间（37.45±11.34）min，分步法组手术时间（55.07±13.57）min，两组间比较差异有统计学意义（P〈0.05）。术后体温≥38.5℃病例一步法组2例，分步法组9例，两组间比较差异有统计学意义（P〈0.05）。术后2周清石率一步法组87.5%（35/40），分步法组82.5%（33/40），两组间比较差异无统计学意义（P〉0.05）。结论＂一步法＂输尿管软镜碎石术治疗嵌顿性输尿管上段结石是一种安全、有效、微创的治疗方法，与＂分步法＂比较具有明显的优势。

Objective To evaluate the effect of ＂one step＂ flexible ureteroscopic lithotripsy for incarcerated upper ureteral calculi. Methods The clinical data of 80 cases of incarcerated upper ureteral calculi were retrospectively analyzed between August 2015 and September 2016. The ＂ one step＂ flexible ureteroseopic lithotripsy was used in 40 cases （ one step group）, including 22 male cases and 18 female cases. The average age was （40.0 ± 9.5 ） yearsl The maximal stone diameter was （ 1.8 ± 0.5 ） cm. The widest width of the ureter above the stone was （2.5 ± 1.1 ） cm. The CT value of stone was （ 1 089.0 ± 111.3）HU. ＂Two step＂ method was used in 40 cases （two step group） ,including 21 male cases and 19 female cases. The average age was （41.0 ± 10.7 ）. The maximal stone diameter was （ 1.7±0.6 ） era. The widest width of the ureter above the stone was （ 2.3 ± 0. 9 ） em. The CT value of stone was （ 1 002.0 ± 97. 2） HU. During the ＂one step＂ flexible ureteroscopic lithotripsy, only flexible ureteroscope was used to crush the stone, no matter whether the stone located in the ureter or return to the renal pelvis. During ＂two step＂ method, the rigid ureteroseopy was firstly used for crushing the stone in the ureter. When the stone return to the renal pelvis, the rigid ureteroseopy was change into flexible ureteroscope for continuous crushing the stone. Compared two groups＂ operating time, 2 weeks stone clearance rate and the cases of fever after operation. Results The mean operative time in the one step group was （ 37.45± 11.34 ） min. The mean operative time in the two step group was（55.07 ± 13.57 ）rain. The difference was statistically significant （ P 〈 0. 05 ）. The number of infection 2 cases in one step group and 9 cases in two step group. The difference was statistically significant （P 〈 0. 05 ）. 2 weeks stone clearance rate was 87.5% （35/40）in one step group and 82.5 % （33/40） in two step group. There was no significant difference between two groups. Conclusions Flexible ureteroscope ＂one step＂ method is a safe and effective alternation for incarcerated upper ureteral calculi.