输尿管软镜碎石术和输尿管硬镜联合NTrap阻石网篮碎石术治疗输尿管上段结石疗效分析

Therapeutic effect of flexible ureteroscopic lithotripsy and NTrap ureteroscopic lithotripsy in the treatment of upper ureteral calculi

目的比较输尿管软镜碎石术(FURL)及输尿管硬镜联合NTrap阻石网篮碎石术(NTrapURL)治疗输尿管上段结石的疗效。方法回顾性分析2012年1月—2018年3月中国医科大学附属第一医院收治的243例行单侧输尿管上段结石碎石术患者的病例资料,按照治疗方法不同将其分为两组:FURL组(n=74)和NTrapURL组(n=169)。FURL组患者采用FURL治疗,NTrapURL组患者采用NTrapURL治疗。以手术时间、术中结石上移、术后无意义残石、术后住院时间、首次结石清除率、近远期并发症(包括疼痛、血尿、发热、输尿管狭窄等)为观察指标,分析2种术式的疗效。符合正态分布的计量资料以均数±标准差(Mean±SD)表示,组间比较采用独立样本t检验;非正态分布的计量资料以中位数(四分位间距)[M(P25,P75)]表示,组间比较采用独立样本的非参数秩和检验;计数资料组间比较采用χ2检验或Fisher确切概率法,等级资料采用有序变量的非参数秩和检验。结果FURL组和NTrapURL组患者的手术时间[(31.08±13.29)min比(33.49±12.10)min]比较,差异无统计学意义(P=0.582)。FURL组和NTrapURL组患者的近期并发症(疼痛:43.24%比50.30%,发热:1.35%比3.55%,血尿:31.08%比23.67%)、远期并发症(0比3.55%)比较,差异无统计学意义(P>0.05);FURL组和NTrapURL组患者的术后住院时间[(2.34±0.96)d比(2.21±0.88)d]比较,差异无统计学意义(P>0.05);FURL组患者的术中结石上移率明显高于NTrapURL组(87.84%比18.93%),差异具有统计学意义(P<0.001);FURL组患者的首次结石清除率高于NTrapURL组(94.59%比81.07%),差异具有统计学意义(P=0.006);FURL组患者的术后无意义残石率明显高于NTrapURL组(31.08%比18.34%),差异具有统计学意义(P=0.043)。结论FURL与NTrapURL均能安全有效地治疗输尿管上段结石,但FURL治疗输尿管上段结石可能拥有更高的术后结石清除率。

Objective To compare the efficacy of flexible ureteroscopic lithotripsy(FURL)and NTrap ureteroscopic lithotripsy(NTrapURL)in the treatment of upper ureteral calculi.Methods A retrospective analysis of the case data of 243 patients undergoing unilateral upper ureteral calculi lithotripsy admitted to the First Hospital of China Medical University from January 2012 to March 2018 were divided into two groups according to different treatment methods:FURL group(n=74)and NTrapURL group(n=169).Patients in the FURL group were treated with FURL,and patients in the NTrapURL group were treated with NTrapURL.Operation time,intraoperative stone moving up,postoperative meaningless residual stone,postoperative hospitalstay,stone-free rate,short-term complications(including pain,hematuria,fever)and long-term complications(including ureteral stenosis)were recorded,two surgical methods were analyzed.The measurement data conforming to the normal distribution were expressed as mean±standard deviation(Mean±SD),and the independent sample t-test was used for comparison between groups;the measurement data of non-normal distribution were expressed as the median(interquartile range)[M(P25,P75)]means that the non-parametric rank sum test of independent samples was used for comparison between groups;the Chi-square test or Fisher exact probability method was used for the comparison of count data between groups,and the nonparametric rank sum test of ordinal variables was used for grade data.Results There was not statistically significant difference between the operation time of patients in the FURL group and the NTrapURL group[(31.08±13.29)min vs(33.49±12.10)min](P=0.582).There was no difference in short-term complications(pain:43.24%vs 50.30%,fever:1.35%vs 3.55%,hematuria:31.08%vs 23.67%)and long-term complications(0 vs 3.55%)in the FURL group and NTrapURL group,there was not statistically significant difference(P>0.05);the postoperative hospital stay of patients in the FURL group and NTrapURL group[(2.34±0.96)d vs(2.21±0.88)d],the difference was not statistically significant(P>0.05);The intraoperative stone movement rate of FURL group was significantly higher than that of the NTrapURL group(87.84%vs 18.93%),and the difference was statistically significant(P<0.001);the first stone clearance rate of the FURL group was higher than that of the NTrapURL group(94.59%vs 81.07%),the difference was statistically significant(P=0.006);the postoperative insignificant residual stone rate in the FURL group was significantly higher than that in the NTrapURL group(31.08%vs 18.34%),and the difference was statistically significant(P=0.043).Conclusion FURL and NTrapURL are safe and effective in the treatment of upper ureteral calculi,but FURL has a higher stone-free in the treatment of upper ureteral calculi.