输尿管软镜联合钬激光治疗上尿路结石的临床研究

Clinical study on flexible ureteroscope combined with holmium laser in treatment of upper urinary calculi

目的探讨输尿管软镜联合钬激光治疗上尿路结石的有效性与安全性。方法选取2014年1月~2016年1月收治的上尿路结石患者200例作为研究对象,按照数字表法随机分为两组,对照组采用经皮肾镜穿刺取石术;观察组患者采用输尿管软镜联合钬激光术;观察两组结石患者的手术时间、术中出血量、术后疼痛、下床活动时间、住院时间、结石清除率及不良反应发生情况。结果观察组患者手术时间、术中出血量等均明显低于对照组,而结石清除率明显高于对照组,且差异均有统计学意义(P<0.05);观察组患者下床活动时间、住院时间等均明显少于对照组,而术后疼痛率明显低于对照组,且差异均有统计学意义(P<0.05);观察组患者不良反应发生率为14.0%,对照组不良反应发生率为24.0%,两组不良反应发生率比较差异有统计学意义(P<0.05)。结论对上尿路结石患者行输尿管软镜下钬激光碎石术,配合术中良好的操作技巧,可以提高肾下盏结石清除率,降低不良反应发生率。

Objective To explore the effectiveness and safety of flexible ureteroscope combined with holmium laser in treatment of upper urinary calculi. Methods 200 patients with upper urinary calculi who were admitted from January 2014 to January 2016 were selected as research objects and they were randomly divided into two groups according to the digital table method.The control group was treated with percutaneous nephrolithotomy.Patients in the observation group was given flexible ureteroscope combined with holmium laser.Operative time,intraoperative blood loss,postoperative pain,out of bed activity time,hospital stay,stone clearance rate and adverse reactions of patients in two groups were observed. Results Operative time and intraoperative blood loss of patients in the observation group were both significantly lower than those of the control group while the stone clearance rate was significantly higher than that of the control group.Comparative differences had statistical difference（P 〈 0.05）.Out of bed activity time and hospital stay of patients in the observation group were both significantly shorter than those of the control group while rate of postoperative pain was significantly lower than that of the control group.Comparative differences had statistical difference（P 〈 O.05）.The incidence of adverse reactions of the observation group and the control group was 14.0% and 24.0% respectively.Comparative difference in incidence of adverse reactions between two groups had statistical significance （P 〈 0.05）. Conclusion For patients with upper urinary calculi,holmium laser lithotripsy under flexible ureteroscope combined with good iutraoperative technique can improve the clearance rate of subrenal calyx calculus and reduce the incidence of adverse reactions.