探讨输尿管软镜钬激光碎石术治疗上尿路结石的疗效

To Investigate the Effect of Flexible Ureteroscope Holmium Laser Lithotripsy in the Treatment of Upper Urinary Calculi

目的研究上尿路结石接受输尿管软镜钬激光碎石术治疗的临床效果.方法选取该院2015年1月—2018年5月收治的48例上尿路结石患者为研究对象,其中输尿管上段结石11例,肾结石37例,结石直径约1.5~3.3 cm,所有患者术前留置双J管2周,全身麻醉下行输尿管软镜钬激光碎石术,术后留置导尿管2~3 d,4~5 d复查KUB.结果 48例患者均成功完成输尿管软镜碎石术,其中43例行一期手术碎石成功,一期碎石成功率为89.58%(43/48);5例患者继续留置双J管2~4周后二期软镜碎石成功,二期碎石成功率为100.00%(48/48)(x^2=4.5162,P=0.0418);综合软镜碎石成功率为100.00%(48/48),所有行软镜碎石患者术后4周复查KUB,总结石清除率为100.00%(48/48).患者术后3个月生活质量评分为(74.22±5.87)分,高于术后1个月(68.49±5.24)分、术前(56.38±4.94)分(P=0.0009、0.0000、0.0000).结论输尿管软镜钬激光碎石术治疗上尿路结石成功率高,且安全性高,值得广泛在临床推广.

Objective To study the clinical effect of holmium laser lithotripsy under flexible ureteroscope for upper urinary calculi. Methods A total of 48 patients with upper urinary tract stones admitted to our hospital from January 2015 to May 2018 were selected as the research objects, including 11 cases of upper ureteral stones, 37 cases of kidney stones, and stone diameter was about 1.5~3.3 cm. All patients were retained double J for 2 weeks before operation. Under general anesthesia, ureteroscopy holmium laser lithotripsy was performed. The catheter was indwelled for 2~3 d, and KUB was reviewed 4~5 d later. Results Forty-three of the 48 patients underwent one-stage ureteroscopic lithotripsy successfully, and the success rate of one-stage lithotripsy was 89.58%(43/48). Five patients continued to retain double J for 2 to 4 weeks, and the success rate of second-stage lithotripsy was 100.00%(48/48)(χ^2=4.516 2, P=0.041 8). The success rate of comprehensive flexible lithotripsy was 100.00%(48/48). The KUB of all patients was recorded at 4 weeks after operation. The stone clearance rate was 100.00%(48/48). Three months after operation, the QOL score was (74.22±5.87)points, which was higher than that that at one month after operation (68.49±5.24)points, and that before operation (56.38±4.94)points (P=0.000 9、0.000 0、0.000 0). Conclusion Soft ureteroscope holmium laser lithotripsy has high success rate and safety in the treatment of upper urinary calculi, which is worthy of clinical promotion.