输尿管镜下斜仰卧半坐截石位激光碎石治疗输尿管上段结石的效果观察

Curative effects of laser lithotripsy with ureteroscopic supine half-sitting lithotomy position under semi supine sit on upper ureteral calculi

目的 评价输尿管镜下斜仰卧半坐截石位激光碎石治疗输尿管上段结石的疗效.方法 选择行输尿管镜下钬激光碎石术的输尿管上段结石患者252例,根据手术方法分为应用结石拦截网篮的传统截石位手术组（A组,n=93）、未应用结石拦截网篮的传统截石位手术组（B组,n=46）与不采用结石拦截网篮斜仰卧半坐截石位手术组（C组,n=113）.分别在术前、术后2 d与术后2周对患者行腹部平片（KUB）检查,评估其结石残留情况.比较三组患者住院费用、手术时间与一期手术成功率.结果 B、C组手术时间少于A组（P〈0.05）;B、C组患者住院费用低于A组（P〈0.05）.C组患者一期碎石成功率高于A、B组（P〈0.05）,且A组一期碎石成功率高于B组（P〈0.05）.结论 斜仰卧半坐截石位充分利用了结石的重力,该体位使肾盂低于肾盏,结石漂移较少,输尿管结石一期碎石率显著提高,治疗费用显著降低,是一种安全有效的截石体位,值得临床推广应用.

Objective To evaluate the curative effects of laser lithotripsy with ureteroscopic supine half-sitting lithotomy position under semi supine sit on upper ureteral calculi. Methods A total of 252 patients with upper ureteral stones who underwent ureteroscopic holmium laser lithotripsy were included. According to the surgical methods, patients were divided into traditional lithotomy surgery group （ group A, n = 93 ） which used a stone interception basket, and traditional lithotomy position surgery group （group B, n = 46） that did not selected the stone interception basket position and group C （n = 113 ） , in which patients did not use a stone interception basket position or supine half-sitting lithotomy position. Before surgery, 2 days and 2 weeks after surgery, patients underwent abdominal plain film examination （KUB examination） to evaluate the residual state of stones. The cost of hospitalization, opera- tion time, and success rate of primary surgery were compared among the three groups. Results The operation time of group B and group C was significantly lower than that of group A （P 〈 0. 05 ） ; the hospitalization costs in group B and group C were significantly lower than that in group A （ P 〈 0. 05 ）. Compared with group A and group B, the success rate of first stage lithotripsy in group C was significantly increased （ P 〈 0. 05 ） ; and the success rate of first stage lithotripsy in group A was significantly higher than that in group B （P 〈 0. 05 ）. Conclusions The supine half-sitting lithotomy position takes full advantage of the gravity of the stone, which makes the renal pelvis lower than the renal pelvis, with less stone drift, by which the success rate of first stage lithotripsy increased significantly, and treatment costs have been significantly reduced. It is a safe and effective lithotomy position and is worthy of clinical application.