铥激光与钬激光治疗输尿管结石合并输尿管狭窄的临床疗效比较

Clinical Study on Efficacy and Safety of Thulium Laser in Treating Complex Urinary Calculi

目的研究铥激光治疗输尿管结石合并输尿管狭窄的临床疗效和安全性。方法选取2015年1月至2017年6月,输尿管结石合并输尿管狭窄患者102例,按照手术方法不同分为铥激光组和钬激光组。其中,铥激光组患者56例,行经尿道输尿管镜下铥激光治疗,激光治疗功率30~120 W,能量3~8 J;钬激光组患者46组,行经尿道输尿管镜下钬激光治疗,激光治疗功率30~60 W,能量2~5 J,频率10 Hz。记录两组患者手术时间和术中出血量;术后3、6和12个月结石清除率、结石复发率、解除狭窄成功率、狭窄复发,以及术中和术后并发症发生情况。结果铥激光组手术时间和术中出血量均明显低于钬激光组,差异具有统计学意义(P<0.05)。术后3个月,两组结石清除率比较,差异无统计学意义(P>0.05);两组患者解除狭窄成功率均为100%。术后3和6个月,两组结石复发率比较,差异无统计学意义(P>0.05);术后12个月铥激光组结石复发率(0.0%)明显低于钬激光组(8.7%)(P<0.05);术后12个月两组患者解除狭窄复发率比较,差异无统计学意义(P>0.05)。两组患者术中并发症比较,差异无统计学意义(P>0.05);铥激光组术后并发症总发生率(1.8%)明显低于钬激光组(13.0%)(P<0.05)。结论铥激光治疗输尿管结石合并输尿管狭窄的临床有效性、安全性以及结石复发率均优于钬激光治疗,值得在临床上推广应用。

Objective To study the clinical efficacy and safety of thulium laser in the treatment of ureteral calculi with ureteral stricture.Methods Totally 102 patients of ureteral calculi accompanied by ureteral stricture and admitted from Jan.2015 to Jun.2017 were divided into two groups by surgical methods:the thulium laser group and holmium laser group.The 56 patients in the thulium laser group were treated with thulium laser under the transurethral ureteroscope.The power of the laser used was 30-120 W,energy 3-8 J.The 46 patients in the holmium laser group were treated with holmium laser under transurethral ureteroscope.The laser power used was 30-60 W,energy was 2-5 J,and frequency 10 Hz.The operation time and intraoperative blood loss of the two groups of patients were recorded;The stone clearance rate,stone recurrence rate,success rate of stenosis relief and stenosis recurrence was calculated respectively 3,6 and 12 months after the operation.The occurrence of intraoperative and postoperative complications was recorded.Results The operation time and bleeding volume of the thulium laser group were significantly lower than those of the holmium laser group(P<0.05).Three months after surgery,there was no statistically significant difference in stone clearance rate between the two groups(P>0.05).The success rates of stenosis relief of both groups were 100%.3 and 6 months after the surgery,there was no significant difference in the recurrence rate of stones between the two groups(P>0.05).The stone recurrence rate(0.0%)in the thulium laser group was significantly lower than that in the holmium laser group(8.7%)12 months after surgery(P<0.05).There was no significant in recurrence difference between the two groups 12 months after surgery(P>0.05).There was no statistically significant difference in intraoperative complications between the two groups(P>0.05).The total postoperative complications rate(1.8%)in the thulium laser group was significantly lower than that(13.0%)in the holmium laser group(P<0.05).Conclusions Thulium laser is characterized by better clinical efficacy,higher safety and lower recurrence rate than holmium laser and is hence worthy of clinical application.