一期与二期行输尿管软镜钬激光碎石术治疗输尿管上段结石的疗效比较

Comparison of the efficacy of first-stage and second-stage flexible ureteroscopic holmium laser lithotripsy in the treatment of upper ureteral calculi

目的 比较术前免留置输尿管支架管(双J管)一期行输尿管软镜钬激光碎石术(FURL)与留置双J管二期行FURL治疗单侧输尿管上段结石的疗效。方法 回顾性分析该院收治的153例直径>1.0 cm单侧输尿管上段单发结石行FURL患者的病历资料,按手术方式分为一期组和二期组。一期组(n=76)术前不留置双J管行FURL,二期组(n=77)术前留置双J管1~2周后行FURL。观察二期组术前留置双J管期间相关并发症发生情况;比较两组的手术成功率,手术成功患者的手术时间、治疗总费用、严重并发症和术后1个月结石清除率。结果 二期组术前留置双J管期间发生的腰痛、血尿、膀胱刺激征及双J管脱落等的并发症为75.3%。一期组手术成功率[93.4%(71/76)]和二期组手术成功率[94.8%(73/77)]比较差异无统计学意义(P>0.05)。一期成功组和二期成功组的手术时间、严重并发症发生率和术后1个月结石清除率比较差异无统计学意义(P>0.05)。一期成功组总费用低于二期成功组,差异有统计学意义(P<0.05)。结论 一期与二期行FURL在治疗输尿管上段结石方面具有相似的安全性和有效性,一期行FURL可避免术前留置双J管期间所致的并发症,降低治疗费用,缩短治疗周期。

Objective To compare the curative effect of flexible ureteroscopic holmium laser lithotripsy(FURL)in the first stage without indwelling ureteral stent(double J tube)and in the second stage with indwelling double J tube in the treatment of unilateral upper ureteral calculi.Methods The clinical data of 153 patients with unilateral upper ureteral calculi with a diameter of more than>1.0 cm who underwent FURL were retrospectively analyzed.According to the operation method,they were divided into the first-stage group and the second-stage group.In the first-stage group(n=76),FURL was performed without indwelling double J tubes before operation,and in the second-stage group(n=77),FURL was performed after indwelling double J tubes for 1-2 weeks before operation.The occurrence of related complications during the preoperative indwelling of double J tubes in the second-stage group was observed.The success rate of operation,operation time,total cost of treatment,serious complications and stone clearance rate at one month after operation were compared between the two groups.Results Complications associated with double J tubes,such as lumbago,hematuria,bladder irritation symptoms and double J tube shedding during the period of preoperative double J welling in the second-stage group were up to 75.3%.The operation success rate of the first-stage group[93.4%(71/76)]was similar to that of the second-stage group[94.8%(73/77)],and there was no significant difference between the two groups(P>0.05).There was no significant difference in the operation time,the incidence of serious complications and the stone clearance rate one month after operation between the first-stage successful group and the second-stage successful group(P>0.05).The total cost of the first-stage successful group was lower than that of the second-stage successful group,and the difference was statistically significant(P<0.05).Conclusion The first-stage and the second-stage of FURL have similar safety and effectiveness in the treatment of upper ureteral calculi.The first-stage of FURL can avoid the complications caused by indwelling double J tubes before operation,reduce the treatment cost and shorten the treatment period.