PCNL FURL术单用及螺旋状套石篮辅助FURL治疗单侧直径大于1.0cm输尿管上段结石的效果对比

The Comparison of PCNL,FURL and Spiral Basket Manipulation Assisted FURL in the Treatment of Upper Ureteral Calculi with Unilateral Diameter>1.0cm

目的:探究经皮肾镜穿刺取石术(PCNL)、输尿管软镜钬激光碎石术(fURL)单用及螺旋状套石篮辅助FURL治疗单侧直径>1.0cm输尿管上段结石的效果对比。方法:前瞻性选取2017年1月至2019年9月在我院进行手术的80例单侧直径>1.0cm输尿管上段结石患者进行研究,按照随机数字表法简单随机分组为A、B、C三组,A组(26例)采用PCNL术治疗,B组(27例)采用FURL术治疗,C组(27例)采用螺旋状套石篮辅助FURL治疗。比较三组患者手术时间、术中出血量、住院时间、碎石成功率、结石清除率、结石上移率及术后并发症发热、血尿、腰部不适的发生率。结果:三组患者手术时间、术中出血量及住院时间比较,差异有统计学意义(P<0.05);B组手术时间、术中出血量及住院时间均低于A组,C组住院时间低于A组,手术时间长于B组,差异均有统计学意义(P<0.05)。三组患者碎石成功率、结石清除率比较,差异有统计学意义(P<0.05);B组碎石成功率、结石清除率分别低于A组、C组,差异均有统计学意义(P<0.05)。三组患者并发症血尿的发生率比较,差异有统计学意义(P<0.05);A组并发症血尿的发生率明显高于B组、C组,差异均有统计学意义(P<0.05)。结论:PCNL和螺旋状套石篮辅助FURL碎石成功率、结石清除率较高,FURL手术时间较短、术中出血量较少、住院时间较短,而PCNL并发症血尿的发生率较高,即螺旋状套石篮辅助FURL是兼顾结石清除率,治疗效果及安全性的一种治疗方法,值得临床推广。

Objective:To explore the effect of PCNL,FURL and spiral basket manipulation assisted FURL in the treatment of upper ureteral calculi with unilateral diameter>1.0cm.Methods:From January 2017 to September 2019,80 cases of upper ureteral calculi with unilateral diameter>1.0cm were prospectively selected for study and categorized into three groups with the random number table method:group A(26 cases)was treated with PCNL;group B(27 cases)was treated with FURL;and group C(27 cases)was treated with spiral basket manipulation assisted FURL.The operating time,intraoperative hemorrhage,length of hospital stay,success rate of lithotripsy,calculus removal rate,calculus migration rate,postoperative fever and hematuria,and incidence of lumbar discomfort were compared among the three groups.Results:There were significant differences in operation time,intraoperative hemorrhage and hospitalization time among the three groups(P<0.05);the operation time,intraoperative hemorrhage and hospitalization time in group B were lower than those in group A,the hospitalization time in group C was lower than that in group A,and the operation time was longer than that in group B(P<0.05).There were significant differences in the success rate of lithotripsy and stone clearance rate among the three groups(P<0.05);the success rate of lithotripsy and stone clearance rate of group B were lower than those of group A and group C respectively(P<0.05).The incidence of complication hematuria in group A was significantly higher than that in group B and group C(P<0.05).Conclusion:PCNL and spiral stone basket assisted furl lithotripsy has a high success rate and stone clearance rate.Furl has a shorter operation time,less bleeding during operation and a shorter hospital stay.However,the incidence of complications of PCNL is higher.That is to say,spiral stone basket assisted furl is a treatment method that takes into account the stone clearance rate,treatment effect and safety,and is worthy of clinical promotion.