输尿管软镜与体外冲击波治疗嵌顿性输尿管上段结石的疗效比较

Comparison of the efficacy of flexible ureteroscope lithotripsy and extracorporeal shock wave lithotripsy in the treatment of impacted upper ureteral calculi

目的:探讨输尿管软镜碎石术(Flexible ureteroscope lithotripsy,FURL)与体外冲击波碎石术(Extracorporeal shock wave lithotripsy,ESWL)治疗嵌顿性输尿管上段结石的效果及安全性。方法:回顾性分析2018年7月—2020年6月我院收治的84例嵌顿性输尿管上段结石患者,按治疗方法不同分为两组,每组各42例,分别给予FURL治疗和ESWL治疗,比较两组患者一次性碎石成功率、住院时间、二次碎石情况、术后1个月结石排净情况、并发症发生率及手术前后生活质量的变化。结果:与ESWL组相比,FURL组一次性碎石成功率、术后1个月结石排净率均更高,并发症发生率更低,住院时间长,治疗费用高,差异均有统计学意义(P<0.05)。两组共13例未能一次性碎石成功,其中ESWL组10例,均行二次ESWL术;FURL组3例,其中2例行二次FURL术,1例行ESWL术。FURL组术后各项生活质量评分均高于ESWL组,差异有统计学意义(P<0.05)。结论:FURL具有碎石成功率高、术后康复快、结石易排净、并发症少及术后生活质量高等优点。

Objective :To explore the effect and safety of flexible ureteroscope lithotripsy(FURL)and extracorporeal shock wave lithotripsy(ESWL)in the treatment of impacted upper ureteral calculi.Methods:Retrospective analysis of the 84 cases admitted to our hospital from July 2018 to June 2020,42 cases in each group. They were divided into two groups according to the treatment method. ESWL treatment and FURL treatment were given respectively,comparing the success rate of single-use gravel,hospital stay,secondary gravel,stone discharge in 1 month after surgery,complications and changes in quality of life before and after surgery.Results:Compared with the ESWL group,the success rate of FURL of one-time disposable gravel,the net rate of stone discharge in 1 month after surgery were higher,the incidence of complications was lower,the hospital stay was longer and the treatment cost was higher,the differences were statistically significant(P<0. 05). In the two groups,13 cases failed to obtain a one-time lithotripsy success,of which 10 cases in the ESWL group underwent ESWL again. In the FURL group,3 cases failed to obtain a one-time lithotripsy success.Among them,2 cases underwent FURL surgery again and 1 case changed to ESWL. The quality-of-life scores of patients in the FURL group were higher than those in ESWL group after surgery,and the difference was statistically significant(P<0. 05).Conclusion :FURL treatment of impacted upper ureteral calculi has the advantages of higher stone crushing rate,more rapid postoperative recovery,easier discharge of stones,fewer complications and better quality of life after surgery.