输尿管镜钬激光碎石术与体外冲击波碎石术治疗输尿管结石的临床比较分析

Clinical Comparative Analysis of Ureteroscope Holmium laser Lithotripsy and Extracorporeal Shock Wave Lithotripsy in the Treatment of Ureteral Calculi

目的比较输尿管镜钬激光碎石术(治疗Ⅰ)与体外冲击波碎石术(治疗Ⅱ)治疗输尿管结石的临床治疗效果。方法在2017年1月—2019年10月在该院泌尿外科接受治疗的68例输尿管结石患者,分为治疗Ⅰ组和治疗Ⅱ组。比较两者治疗输尿管结石的手术时间、术后3个月结石排净率及手术并发症发生率的差异。结果治疗Ⅰ组治疗结石明显少于治疗Ⅱ组的平均手术时间,差异有统计学意义(P<0.01);对直径>1.0 cm的输尿管结石,治疗Ⅰ组术后3个月结石排净率为87.5%,明显高于治疗Ⅱ组的82.4%,差异有统计学意义(χ^2=4.670,P<0.05);而对于直径≤1.0 cm的输尿管结石,治疗Ⅰ组和治疗Ⅱ组术后3个月结石排净率分别为88.8%和64.7%,差异无统计学意义(χ^2=3.010,P>0.05)。治疗Ⅱ组上段结石的有效率为81.3%,显著低于中下段结石66.7%,差异有统计学意义(P<0.05);治疗Ⅰ组并发症发生率为2.3%,治疗Ⅱ组无明显并发症发生。结论综合考虑,通常将直径>1.0 cm并伴有输尿管息肉及输尿管狭窄的结石,特别是处于中下段的结石,首先选择的治疗方案就是镜钬激光碎石术。

Objective To compare the clinical effects of ureteroscopy holmium laser lithotripsy(treatmentⅠ)and extracorporeal shock wave lithotripsy(treatmentⅡ)in the treatment of ureteral calculi.Methods From January 2017 to October 2019,68 patients with ureteral calculi who were treated in the hospital’s urology department were divided into treatment group I and treatment groupⅡ.The difference between the operation time of ureteral calculi,the net rate of stone discharge at 3 months and the incidence of surgical complications were compared between the two groups.Results The treatment stones in treatment group I were significantly shorter than the average operation time in treatment group II,and the difference was statistically significant(P<0.01).For ureteral stones>1.0 cm in diameter,the net rate of stone removal in the first three months after treatment was 87.5%in the treatment group I,which was sig-nificantly higher than 82.4%in the treatment group II,the difference was statistically significant(χ^2=4.670,P<0.05).For ureteral stones with a diameter of≤1.0 cm,the net rate of stones in the treatment group I and treatment groupⅡat 3 months after surgery was 88.8%and 64.7%,respectively,with no statistically significant difference(χ^2=3.010,P>0.05).The effective rate of treatment of upper calculi in groupⅡwas 81.3%,which was significantly lower than that of middle and lower calculi 66.7%,and the difference was statistically significant(P<0.05).The incidence of complications in treatment group I was 2.3%,and no obvious complications oc-curred in treatment group II.Conclusion The first treatment option is holmium laser lithotripsy for stones>1.0 cm in diameter with ureteral polyps and ureteral stenosis,especially those in the lower middle section.