输尿管镜内置不同管径输尿管导管引流在输尿管结石治疗中的应用

Application of ureteral catheters with different diameters built into ureteroscope in the treatment of ureteral calculus

目的比较内置4F、5F输尿管导管联合钬激光碎石治疗输尿管结石的疗效和安全性。方法2020年1月~2021年3月间我院治疗的输尿管结石病人68例,根据内置输尿管导管管径不同分为两组,4F组32例,采用输尿管镜内置4F输尿管导管引流碎石术,5F组36例,采用输尿管镜内置内置5F输尿管导管引流碎石术,比较两组围手术期指标、结石清除率及术后并发症发生率。结果5F组最高肾盂压力(21.5±3.0)mmHg低于4F组的(24.3±3.9)mmHg,输尿管导管引流液温度(26.4±2.9)℃低于4F组的(31.3±3.6)℃,堵管次数(2.1±0.3)低于4F组的(2.9±0.5),结石最大位移距离(1.6±0.3)cm,低于4F组的(2.2±0.4)cm,差异均有统计学意义(P<0.05),而两组手术时间、结石清除率、发热率比较差异无统计学意义(P>0.05)。两组术后均无输尿管穿孔、黏膜撕脱发生。结论输尿管镜内置5F输尿管导管与内置4F输尿管导管碎石术治疗输尿管结石安全有效,但内置5F输尿管导管可降低术中最高肾盂压力及输尿管导管引流液温度,减少结石上移距离。

Objective To compare the efficacy and safety of built-in 4F ureteral catheter and built-in 5F ureteral catheter combined with holmium laser lithotripsy in the treatment of ureteral calculus.Methods The clinical data of 68 calculus patients treated in our hospital from January 2020 to March 2021 were collected.Two groups were divided according to the different diameters built into ureteroscope,32 patients underwent ureteroscope built-in 4F ureteral catheter drainage lithotripsy(4F group),and 36 patients underwent ureteroscope built-in 5F ureteral catheter drainage lithotripsy(5F group).The perioperative results,calculus removal rate,and postoperative complication rate were compared between the two groups.Results The highest renal pelvic pressure(21.5±3.0)mmHg in the 5F group were lower than those in the 4F group(24.3±3.9)mmHg,ureteral catheter drainage temperature(26.4±2.9)℃,were lower than those in the 4F group(31.3±3.6)℃,number of tube blockages(2.1±0.3)were lower than those in the 4F group(2.9±0.5),and maximum calculus displacement distance(1.6±0.3)cm were lower than those in the 4F group(2.2±0.4cm),and the differences between the two groups were statistically significant(P<0.05).However,there was no statistical difference in operation time,calculus removal rate,and fever rate between the two groups(P>0.05).There was no ureteral perforation or mucosal avulsion in both groups after operation.Conclusion The ureteroscopy built-in 5F ureteral catheter and built-in 4F ureteral catheter lithotripsy are safe and effective for the treatment of ureteral calculus.However,the built-in 5F ureteral catheter can reduce the maximum intraoperative renal pelvic pressure and the temperature of the ureteral catheter drainage fluid,and reduce the distance of the calculus moving up.