经皮肾镜气压弹道与钬激光治疗输尿管上段≤2cm嵌顿性结石术后疗效对比分析

Clinical comparative study of percutaneous nephrolithotomy with pneumatic lithotripsy and holmium laser lithotripsy in the treatment of impacted proximal ureteral calculi that less than 2 cm

目的 比较分析钬激光与气压弹道在经皮肾镜中治疗输尿管上段≤2 cm嵌顿性结石的临床疗效,为寻其一种更为安全有效的碎石工具治疗该类结石.方法 回顾性分析本院2014年1月至2016年12月收治的122例L4椎体以上≤2 cm的单纯性输尿管上段嵌顿性结石临床资料,将患者随机平均分为两组（各61例）,分别行经皮肾镜钬激光碎石及气压弹道碎石,比较分析两组手术时间、出血量、Ⅰ期结石清除率、住院费用及并发症等.结果 气压弹道组与钬激光组在手术时间、出血量及Ⅰ期结石清除率方面并无明显差异（P＞0.05）,住院费用气压弹道组[（14 186.54 ±741.58）元]低于钬激光组[（16 628.84±881.21）元],差异具有统计学意义（P＜0.05）;术中输尿管穿孔发生率：气压弹道组[1.64％（1/61）]低于钬激光组[11.5％ （7/61）],差异具有统计学意义（P＜0.05）;术后输尿管狭窄：气压弹道组[3.28％ （2/61）]明显低于钬激光组[19.67％（12/61）],差异具有统计学意义（P＜0.05）.未见输尿管撕脱伤及感染性休克等严重并发症.结论 在经皮肾镜手术中气压弹道碎石及钬激光碎石均为有效的碎石工具,但前者其对输尿管损伤较小,术后输尿管狭窄发生率较低,具有更好的安全性,并且减低了患者经济负担,值得临床推广应用.

Objective To compare the efficacy of percutaneous nephrolithotomy with pneumatic lithotripsy and holmium laser lithotripsy in the treatment of impacted upper ureterolithiasis less than 2 cm,searching for a more safe and effective lithotripsy tool.Methods A retrospective analysis of clinical data of 122 cases diagnosed as impacted proximal ureteral calculi that L4 more than 2 cm of simple vertebral was taken.All patients were randomly divided into two groups,each group 61 cases,and underwent percutaneous nephrolithotomy with pneumatic lithotripsy and holmium laser lithotripsy,respectively.Hospital costs,the operation time,bleeding volume,stone Ⅰ period clearance rate,and complications were compared.Results There was no significant difference in the operation time,bleeding volume and I stone clearance rate between pneumatic lithotripsy group and holmium laser group （P 〉 0.05）,hospitalization expenses of pneumatic lithotripsy [（14 186.54 ± 741.58） yuan] was lower than that of holmium laser group [（16 628.84 ± 881.21） yuan],the difference was statistically significant （P 〈 0.05）.Incidence of ureteral perforation during operation in pneumatic lithotripsy group [1.64% （1/61）] was lower than the holmium laser group [11.5% （7/61）],the difference was statistically significant （P 〈 0.05）.Postoperative ureteral stenosis in pneumatic lithotripsy group [3.28% （2/61）] was significantly lower than that of holmium laser group [19.67% （12/61）],the difference was statistically significant （P 〈 0.05）.There were no severe complications such as avulsion of ureter and septic shock.Conclusions Both percutaneous nephrolithotomy with pneumatic lithotripsy and with holmium laser lithotripsy in the treatment of impacted proximal ureteral calculi are effective lithotripsy tools.But the former has advantages with fewer ureteral damage,low postoperative ureteral stenosis rate and better security,at the same time it reduces the economic burden of the patients,worth clinical popularizing and application.