钬激光与气压弹道碎石术治疗ESWL失败后的输尿管中下段结石的临床疗效比较

Comparison of curative effect of holmium laser and pneumatic lithotripsy treatment for middle and lower ureteral calculi after the failuer of ESWL

目的比较输尿管镜下钬激光与气压弹道碎石术(PL)两种手术方式治疗体外冲击波碎石术(ESWL)失败后的输尿管中下段结石的临床疗效,方法回顾性分析2012年10月至2015年8月徐州医科大学附属医院收治的90例经ESWL治疗失败后的输尿管中下段结石患者的病例资料:根据手术方式不同将患者分为两组:钬激光组(PL组)和气压弹道组(组),每组各45例。比较两组患者的手术时间、术后住院时间、住院费用、术后血红蛋白(Hb)下降量、一次性结石清除率、1周结石排净率和手术并发症(如发热、穿孔、血尿、输尿管穿孔)发生率。结果PL组的手术时间[(67.11±15.69)min]大于HL组[(57.40±20.22)min],术后住院时间[(5.82±2.79)d]大于HL组[(4.07±1.43)d]、Hb下降量[(10.87±7.93)g/L]大于HL组[(5.31±5.99)g/L],两组比较差异均有统计学意义(P<0.05);但两组的并发症总发生率及住院总费用比较,差异无统计学意义(P>0.05)HL组的结石清除率及术后排净率高于PL组,差异有统计学意义(P<0.05)。结论输尿管镜下钬激光碎石术(HL)是治疗ESWL失败后的中下段输尿管结石的一线方案。HL有较高的一次性碎石率、手术时间短、术后恢复快等优点,是治疗ESWL失败后中下段输尿管结石安全有效的方式。

Objective To compare the clinical efficacy and safety of ureteroscopic holmium laser and pneumatic lithotripsy in treating middle and lower ureteral calculi after the failure of extracorporeal shock wave lithotripsy(ESWL).Methods Ketrospective analysis of clinical data of 90 patients with middle and lower ureteral calculi after ESWL treatment failure who treated in the affiliated hospital of Xuzhou medical university from October 2012 to August 2015 was performed.Patients were divided into two groups according to different surgical methods:holmium laser group and pneumatic lithotripsy group,with 45 patients in each group.The two groups were compared in operation time,postoperative hospitalization time,hospitalization cost,and the decreased amount of hemoglobin after surgery,success rate of lithotripsy,One week stone removal rate and incidence of surgical complications.Results The operation time in the PL group was longer than that in the HL group,the postoperative hospital stay was longer than that in the HL group,the decrease in hemoglobin was larger than that in the HL group.The difference between the two groups was statistically significant(P<0.05).There was no significant difference in the total incidence of complications and total hospitalization costs between the two groups(Z5>0.05).I he clearance rate and postoperative clearance rate of the HL group were higher than that of the PL group,the difference was significant(P<0.05).Conclusions Ureteroscopic holmium laser is the first line of treatment for middle and lower ureteral calculi after ESWL failure.It has the advantages of higher disposable lithotripsy rate,shorter operation time,faster postoperative recovery,which is a safe and effective way to treat middle and lower ureteral calculi after ESWL failure.