预置导丝在输尿管镜处理复杂性输尿管结石中的应用

The application of pre-set guide wire in ureteroscopic treatment of complex ureteral calculi

目的探讨预置安全导丝在输尿管硬镜处理复杂性输尿管结石中的安全性及实用性。方法回顾性分析本院泌尿外科2017年7月至2021年2月期间收治的273例复杂性输尿管结石患者,根据术中是否放置导丝分为两组:导丝组采用预置安全导丝下行输尿管硬镜钬激光治疗复杂性输尿管结石的患者共143例,对照组采用输尿管镜直接行钬激光处理结石的患者共130例,观察两组在手术成功率、结石清除率、结石逃逸率、术中并发症发生率进行对比分析,并探讨预置安全导丝手术方式的临床应用价值。结果导丝组143例均取得手术成功,成功率100%(143/143);对照组102例手术成功,成功率78.4%(102/130);两组间差异具有统计学意义(P<0.05)。输尿管上段结石手术时,导丝组有15例逃逸至肾盂,逃逸率18.0%(15/83),对照组25例逃逸至肾盂,逃逸率34.7%(25/72),两组间差异具有统计学意义(P<0.05);输尿管中下段结石手术时,导丝组3例逃逸肾盂,上移率5%(3/60);对照组7例移入肾盂,上移率12.1%(7/58),两组间差异无统计学意义(P>0.05);输尿管腔道丢失率方面:导丝组无病例出现腔道丢失,腔道丢失率0%;对照组16例出现腔道丢失,腔道丢失率12.3%(16/130);两组间差异具有统计学意义(P<0.05);输尿管损伤率方面:观察组8例发生输尿管损伤,损伤率5.5%(8/143);对照组25例发生输尿管损伤,损伤率19.2%(25/130);两组间差异具有统计学意义(P<0.05)。结论采用预置安全导丝法处理复杂性输尿管结石可以提高手术成功率,减少输尿管损伤及手术并发症,是安全有效的手术方式,值得临床推广和应用。

Objective To explore the safety and practicability of the preset safety guide wire in the ureteroscopic treatment of complex ureteral stones.Methods A retrospective analysis was performed on 273 patients with complicated ureteral calculi admitted to the Department of Urology,First Affiliated Hospital of Soochow University from July 2017 to February 2021.The patients were divided into two groups.The guide wire group had a total of 143 patients who were with complicated ureteral calculi and they were treated with ureteroscope and holmium laser by using a preset safety guide wire.In the control group,130 patients who used ureteroscope to reach the position of the stone and then withdrew the guide wire,and then directly treated the stone with holmium laser.The stone clearance rate,stone escape rate,and intraoperative complication rate were compared and analyzed,and the clinical application value of the pre-installed safe guide wire surgical method was discussed.Results 143 cases in the guide wire group were successfully operated with a success rate of 100%(143/143).102 cases in the control group were successfully operated with a success rate of 78.4%(102/130).The difference between the two groups was statistically significant(P<0.05).During upper ureteral calculi surgery,15 patients in the guide wire group escaped to the renal pelvis,with an escape rate of 18.0%(15/83),and 25 patients in the control group escaped to the renal pelvis,with an escape rate of 34.7%(25/72).The difference between the two groups was statistically significant(P<0.05).During the operation of the middle and lower ureteral calculi,3 patients in the guide wire group escaped the renal pelvis,with an upward shift rate of 5%(3/60).7 patients in the control group moved into the renal pelvis,with an upward shift rate of 12.1%(7/58),the difference between the two groups was not statistically significant(P>0.05).In terms of ureteral lumen loss rate,no cases in the guide wire group had lumen loss,and the lumen loss rate was 0.0%.16 cases in the control group had lumen loss.Cavity loss rate was 12.3%(16/130).The difference between the two groups was statistically significant(P<0.05).In terms of ureteral injury rate,the ureteral injury occurred in 8 cases in the observation group,and the injury rate was 5.5%(8/143).In the control group,25 cases of ureteral injury occurred,the injury rate was 19.2%(25/130)and the difference between the two groups was statistically significant(P<0.05).After the operation,the two groups of patients were followed up for 2 to 5 months.Conclusion Pre-installed safe guide wire method to treat complicated ureteral calculi can increase the success rate of surgery,reduce ureteral injury and surgical complications.It is a safe and effective surgical method,and it is worthy of clinical promotion and application.