一期输尿管软镜钬激光碎石术治疗≤2 cm单侧上尿路结石的临床研究

Efficacy and safety of same-session flexible ureteroscopic lithotripsy for unilateral upper urinary tract calculi 2cm or smaller

目的对比研究术前免留置输尿管支架管的一期输尿管软镜与留置输尿管支架管的二期输尿管软镜钬激光碎石术的相关指标,探讨一期输尿管软镜钬激光碎石术治疗单侧上尿路结石的有效性和安全性。方法回顾性分析2016年1月至2017年6月我院收治的≤2 cm单侧肾及输尿管上段结石行输尿管软镜钬激光碎石术患者的临床资料,240例患者符合纳入标准,其中一期手术组和二期手术组各120例。比较两组患者手术时间、软镜鞘置入成功率、碎石成功率、术后住院时间、术后并发症率、术后1个月结石清除率。结果两组患者手术时间、软镜鞘置入成功率、碎石成功率、术后住院时间、术后并发症发生率、术后1个月结石清除率比较差异均无统计学意义(P>0.05)。两组住院次数及费用相比,术前免留置输尿管支架管的一期输尿管软镜钬激光碎石术能减少患者住院次数及费用。结论一期输尿管软镜与二期输尿管软镜钬激光碎石术在治疗≤2 cm单侧上尿路结石中具有相似的安全性和有效性。

ObjectiveTo evaluate the efficacy and safety of same-session flexible ureteroscopy （f-URS） with holmium laser without preoperative ureteral stent placement for treatment of unilateral upper urinary tract calculi 2 cm or smaller in comparison with staged flexible ureteroscopy with preoperative ureteral stent placement. MethodsThe clinical data were retrospectively analyzed for 240 patients undergoing unilateral f-URS with holmium laser for unilateral renal and proximal urinary calculi 2 cm or smaller in our department between January, 2016 and June, 2017. Of these patients, 120 received same-session unilateral f-URS surgery without a preexistent ureteral stent and the other 120 underwent staged surgery with preoperative ureteral stent placement. The operation time, the success rates of ureteral access sheath placement and lithotripsy, postoperative hospital stay, postoperative complication rate, and the stone-free rate （SFR） at 1 month after the operation were compared between the 2 groups. ResultsNo significant differences were found between the 2 groups in the operation time, success rate of ureteral access sheath placement, success rate of lithotripsy, postoperative hospital stay, postoperative complication rate, or the stone-free rate （ SFR） at 1 month postoperatively （P〉0.05）. The patients receiving same-session ureteroscopy without a preexistent ureteral stent, however, had fewer hospital admissions with lower hospital expenditure than those receiving staged ureteroscopy with preoperative ureteral stent placement. ConclusionSame-session flexible ureteroscopy without a preexistent ureteral stent and staged surgery with preoperative ureteral stent placement have similar efficacy and safety for treatment of unilateral upper urinary tract calculi 2 cm or smaller.