一体式软硬质输尿管肾镜治疗输尿管上段及肾盂结石的临床观察

Application of integrated flexible and rigid ureterorenoscope in upper ureter or renal pelvis stones

目的评估一体式软硬质输尿管肾镜在输尿管上段及肾盂结石的治疗的有效性及安全性.方法回顾性分析2015年1月至2017年7月因输尿管上段结石或肾盂结石于解放军第174医院泌尿外科住院手术治疗的48例患者的临床资料.其中25例患者采用一体式软硬质输尿管肾镜钬激光碎石术治疗(一体镜组),23例患者则行微创经皮肾镜碎石取石术(mPCNL组).比较两组患者手术效果及手术安全性.结果一体镜组结石寻及率为96%,mPCNL组为100%.一体镜组手术出血量为(6.83±2.60)mL较mPCNL组(75.57±18.85)mL低,差异具有统计学意义(P<0.05);在手术时间比较上,一体镜组为(59.79±9.93)min较mPCNL组(126.52±17.56)min低,在术后住院时间比较上,一体镜组(4.25±1.36)d,较mPC-NL组(7.35±2.56)d低.在结石清除率比较上,一体镜组与mPCNL组相比差异无统计学意义(P>0.05),仅一体镜组1例患者术后辅助体外冲击波碎石术(ESWL)治疗.两组的术后并发症比较差异无统计学意义.结论一体式软硬质输尿管镜钬激光碎石术在输尿管上段及肾盂结石治疗上,安全有效,具有很高的清石率,可达到与mPCNL相似的清石效果,与mPCNL相比,具有手术出血少、手术时间短、治疗费用低、术后恢复快、并发症少等优点,有广阔的运用前景.

Objective To study the efficacy and safety of the integrated flexible and rigid ureterorenoscope in the treatment of upper ureter or renal pelvis stones.Methods The clinical data of 48 patients with upper ureter or renal pelvis stones were retrospectively analyzed between January 2015 and July 2017.Twenty-five cases were treated with integrated flexible and rigid ureterorenoscope(integrated group),while 23 cases were treated with minimally invasive percutaneous nephrolithotomy lithotripsy(mPCNL group).The operative effect and safety of both groups were compared.Results In the integrated group,stone fin ding rate was 96%and 100%in the mPCNL group.The blood loss of the integrated group was(6.83±2.60)mL lower than that of the mPCNL group(75.57±1&85)mL(P<0.05).The comparison of operation time,the integrated group was(59.79±9.93)min lower than the mPCNL group(126.52±17.56)min.The postoperative hospital stay in integrated group(4.25±1.36)d was lower than the mPCNL group(7.35±2.56)d.The stone clearance rate in integrated group was 91.67%and 95.65%in mPCNL group,the comparation between the two groups showed no statistically significant(P>0.05).There was no significant differenee in postoperative complications between the two groups.Conclusions The integrated flexible and rigid ureterorenoscope is safe and effective in the treatment of the upper ureter and renal pelvis stones.With a high stone clearance rate,it can achieve the similar clear stone effect of mPCNL.Compared with mPCNL,the integrated flexible and rigid ureterorenoscope has less bleeding,shorter operative time,lower cost of treatment,faster recovery after surgery,less complications,with broad prospects for the use.