输尿管镜联合阻石网篮与输尿管软镜治疗直径大于1.5cm输尿管上段结石的疗效、安全及经济性对比分析

Comparison of the Efficacy,Safety and Cost-effectiveness of Ureteroscopic Lithotripsy with Stone-resistance Basket and Flexible Ureteroscopic Lithotripsy for the Treatment of Upper Ureteral Calculi Larger than 1.5 cm

目的比较输尿管镜联合阻石网篮(即Stone cone拦截下输尿管镜碎石术,sURL)与输尿管软镜碎石术(fURL)治疗直径大于1.5cm输尿管上段结石的临床疗效、安全性及经济性。方法回顾性分析作者单位于2015年1月至2018年1月收治的单侧直径>1.5cm输尿管上段结石患者共161例,将入组患者分为两组,包括sURL组(85例)和fURL组(76例)。比较分析两组患者的围手术期指标、一期碎石成功率、严重并发症发生率、住院费用及成本效益比。结果两组的一期碎石成功率比较,差异无统计学差异(P>0.05)。sURL组在手术时间[分别为(65.8±27.1)分钟和(76.7±24.1)分钟]及术后住院天数指标[分别为(2.0±2.4)天和(2.4±4.8)天]均短于fURL组,ClavienⅢ级及以上严重并发症在本次入组患者内均未发生。sURL在成本效益比中明显低于fURL(P<0.05)结论sURL治疗输尿管上段结石能够减少结石上移,提高碎石成功率,在临床疗效、安全性方面与fURL相比,差异无统计学意义,且有较高的成本效益优势,具有良好的临床价值。

Objective To compare the clinical efficacy,safety and cost-effectiveness of ureteroscopic lithotripsy with Stone Cone stone-resistance basket(sURL)and flexible ureteroscopic holmium laser lithotripsy(fURL)for the treatment of upper ureteral calculi which larger than 1.5 cm.Methods The clinical data of 161 patients with unilateral upper ureteral calculi which diameters were over 1.5 cm were recruited in the authors’department from Jan.2015 to Jan.2018.The enrolled patients were divided into two groups,the sURL group(85 cases)and the fURL group(76 cases).The perioperative clinical indicators,one-stage stone-clearance rate,incidence of serious complications,hospitalization costs and cost-effectiveness ratio were compared between these two groups.Results There was no significant difference between the two groups in one-stage stone clearance rate.The operation time[(65.8±27.1)minutes vs(76.7±24.1)minutes]and the postoperative hospitalization[(2.0±2.4)days vs(2.4±4.8)days]in sURL group was shorter than those of the fURL group(P<0.05).No severe complications(Clavien gradeⅢand above)occurred in either group.The cost-effectiveness ratio of the sURL group was obviously lower than tha of the fURL group.Conclusions The sURL for the treatment of unilateral upper ureteral stones larger than 1.5 cm can effciently reduce the stone removal risk,improve the stone clearance rate,and the clinical efficacy and safety is similar to fURL.Moreover,it also has the advantage of better cost-effectiveness.