气压弹道碎石术或钬激光碎石术治疗复杂性上尿路结石的临床疗效

Clinical Efficacy of Percutaneous Nephroscope Supersonic Pneumatic Ballistic Lithotripsy or Holmium Laser Lithotripsy on Treating Complex Upper Urinary Tract Calculi

目的:观察经皮肾镜超声气压弹道碎石术或钬激光碎石术治疗复杂性上尿路结石的临床疗效。方法:泌尿外科就诊的复杂性上尿路结石患者400例,随机法均分为气压弹道碎石组和钬激光碎石组;记录两组患者的基本资料(年龄、性别、结石大小、结石分布,术前肾积水和输尿管积水等资料),观察两组患者的平均手术时间、碎石取石时间、术中出血量、术后住院时间、术后血尿时间、术后3个月肾、输尿管积水缓解率及术后1年结石复发率。结果:气压弹道碎石组在手术时间、碎石取石时间、术中出血量及术中输尿管穿孔率方面优于钬激光碎石组,差异有统计学意义(P<0.05);气压弹道碎石组的平均术后住院时间短于钬激光碎石组,差异有统计学意义(P<0.05);钬激光碎石组的术后血尿持续时间短于气压弹道碎石组,差异有统计学意义(P<0.05);两组术后3个月肾、输尿管积水缓解率及术后1年结石复发率比较,差异无统计学意义(P>0.05)。结论:治疗复杂性上尿路结石经皮肾镜超声气压弹道碎石术或较钬激光碎石术具有一定的优势,是一种安全有效的碎石方法。

Objective： To investigate clinical efficacy of percutaneous nephroscope supersonic pneu- matic ballistic lithotripsy and holmium laser lithotripsy on treating complex upper urinary tract calculi. Methods： 400 patients with complex upper urinary tract calculi and they were randomly divided into two groups： pneumatic ballistic lithotripsy group （200） and holmium laser lithotripsy group （200）. Recording general information （age, gender, size and distribution of stones, hydronephrosis and hydroureterosis before operation, etc） of both groups; observing following of both groups： average op- eration time, lithotripsy time, amount of bleeding during operation, hospitalization time ＇after opera- tion, hematuria time after operation, remission rate of hydronephrosis and hydroureterosis 3 months af- ter operation, and calculi recurrence rate 1 year after operation. Results： Concerning average opera- tion time, lithotripsy time, amount of bleeding during operation and ureter punching rate of pneumatic ballistic lithotripsy group were better than that of holmium laser lithotripsy group, differences were sta- tistically significant（ P 〈0.05 ） ; average hospitalization time after operation of pneumatic ballistic lith- otripsy group was shorter than holmium laser lithotripsy group, differences were statistically significant （P 〈 0.05 ） ; hematuria time after operation of holmium laser lithotripsy group was shorter than pneu- matic ballistic lithotripsy group, differences were statistically significant（P 〈 0.05 ） ; remission rate of hydronephrosis and hydroureterosis 3 months after operation, and calculi recurrence rate 1 year after operation of both groups showed no statistical significance （P 〉 0.05 ）. Conclusion ： Pneumatic ballis- tic lithotripsy had certain advantages compared to holmium laser lithotripsy, which could be a safe and effective method.