输尿管导引鞘配合改良侧卧位输尿管硬镜钬激光碎石治疗复杂输尿管上段结石的临床研究

Clinical Study of Ureteral Access Sheath Combined with Modified Lateral Decubitus Rigid Ureteroscopic Holmium Laser Lithotripsy in Treatment of Complex Upper Ureteral Calculi

目的:探讨输尿管导引鞘配合改良侧卧位输尿管硬镜钬激光碎石治疗复杂输尿管上段结石的临床效果。方法:选取2020年6月—2022年12月柳州市柳江区中医医院收治的60例复杂输尿管上段结石患者作为研究对象,随机分为两组,各30例。对照组予以经皮肾镜钬激光碎石术治疗,观察组予以输尿管导引鞘配合改良侧卧位输尿管硬镜钬激光碎石治疗,比较两组结石清除率、并发症发生情况、住院时间、总医疗费用、手术时间。结果:两组一次性结石清除率,拔双J管后1 d、1个月结石清除率比较,差异无统计学意义(P>0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.001)。观察组住院时间短于对照组,总医疗费用少于对照组,差异有统计学意义(P<0.001);两组手术时间比较,差异无统计学意义(P>0.05)。结论:输尿管导引鞘配合改良侧卧位输尿管硬镜钬激光碎石治疗复杂输尿管上段结石的效果理想,患者并发症发生率低,安全性高,恢复速度较快,医疗费用较低,值得临床推广。

Objective:To explore the clinical effect of ureteral access sheath combined with modified lateral decubitus rigid ureteroscopic holmium laser lithotripsy in the treatment of complex upper ureteral calculi.Methods:From June 2020 to December 2022,60 patients with complex upper ureteral calculi treated in Liuzhou City Liujiang District Hospital of Traditional Chinese Medicine were selected as the study subjects.They were randomly divided into two groups,with 30 cases each.The control group was treated with percutaneous nephrolithotomy with holmium laser lithotripsy and the observation group was treated with ureteral access sheath combined with modified lateral decubitus rigid ureteroscopic holmium laser lithotripsy.The calculi clearance rate,complications,length of hospital stay,total medical expenses,and operation time were compared between the two groups.Results:There was no significant difference in one-time calculi clearance rate and calculi clearance rate at 1 d and 1 month after double J tube extubation between the two groups(P>0.05).The incidence of complications in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.001).The length of hospital stay in the observation group was shorter than that in the control group,and the total medical expenses in the observation group were less than that in the control group,and the difference was statistically significant(P<0.001).There was no significant difference in operation time between the two groups(P>0.05).Conclusion:The effect of ureteral access sheath combined with modified lateral decubitus rigid ureteroscopic holmium laser lithotripsy is ideal in the treatment of complex upper ureteral calculi,with a low complication rate,high safety,faster recovery speed and low medical expense,which is worthy of clinical promotion.