输尿管软镜治疗双侧上尿路结石一期与多期的疗效比较

Curative effect of same-session bilateral versus staged unilateral flexible ureteroscopic lithotripsy for upper urinary system stones

目的探讨输尿管软镜治疗双侧上尿路结石一期与分期手术的临床疗效评估。方法收集本院2014年1月至2017年1月治疗的术前总肾功能正常的双侧上尿路结石患者,随机分为一期手术治疗患者43例(一期组),分期治疗患者55例(分期组);比较一期组同分期组患者总手术时间、总住院时间、结石清除率、并发症发生率、总费用。结果一期手术中转分期手术3例,术式改变率6.97%,分期手术均顺利完成手术;一期手术组总手术时间同分期手术组差异无统计学意义[(138.5±21.0)min vs.(128.6±27.3)min,P>0.05],一期组总住院时间较分期组总住院时间明显较短[(3.5±1.8)d vs.(7.6±3.5)d,P<0.05];两组患者分别于术后第4周复查泌尿系CT评估结石清除率分别为(84.73±3.51)%、(91.52±3.13)%。差异具有统计学意义(P<0.05);两组术后并发症发生率无统计学意义(P>0.05);总费用一期手术较分期手术节约1/3,存在明显差异。结论双侧上尿路结石输尿管软镜一期钬激光碎石术安全、有效,较分期治疗明显节约医疗成本,但需严格把握手术适应证。

Objective To investigate curative effect of same-session bilateral versus staged unilateral flexible ureteroscopic lithotripsy for upper urinary system stones.Methods From January 2014 to January 2017,data of patients with bilateral upper urinary stones whose renal function was normal were collected.Forty-three patients were treated by one stage flexible ureteroscopic lithotripsy,while 55 patients were given stage therapeutics.Different groups with total operation time,total length of hospital stay,stone clearance rate and complication rates and total cost were compared.Results Three cases in stage I transit to multi-period,change rate was 6.97%,staging surgery was successfully completed.There was no significant difference in total operation time between two groups[(138.5±21.0)min vs.(128.6±27.3)min,P>0.05].The total length of hospital stay in the one stage group was obviously shorter than the multi-period[(3.5±1.8)d vs.(7.6±3.5)d,P<0.05].There was statistically difference in calculi clearance between the two groups 4 weeks post-operation[(84.73±3.51)%vs.(91.52±3.13)%,P<0.05].Complication rates of two groups were 7.50%vs.9.09%(P>0.05).Total cost in one stage group saved 1/3 compared with multi-period.Conclusions Stage I flexible ureteroscopic lithotripsy for urinary stones on the both sides is safe,effective,the one stage treatment significantly saves medical cost.