输尿管软镜与输尿管硬镜联合拦截网篮钬激光碎石术治疗输尿管上段结石的随机对照临床研究

Flexible ureteroscopic holmium laser lithotripsy and rigid ureteroscopic holmium laser lithotripsy with N-Trap in the treatment of upper ureteral calculi:a randomized controlled clinical trial

目的:分析输尿管软镜钬激光碎石术与输尿管硬镜联合拦截网篮钬激光碎石术治疗输尿管上段结石的临床效果。方法:选取2021年10月至2023年4月上海中医药大学附属上海市中西医结合医院收治的直径>10 mm的输尿管上段结石92例,随机分入软镜组46例和硬镜组46例,软镜组接受输尿管软镜钬激光碎石术,硬镜组接受输尿管硬镜联合拦截网篮钬激光碎石术。将两组患者根据肾下极水平线分为上部、下部亚组,比较整体及亚组间的手术成功率、手术时间、严重并发症和1个月结石清除率、3个月结石清除率。结果:两组手术成功率比较:整体上软镜组(95.7%)明显高于硬镜组(80.4%);分亚组比较,软镜上部组(96.0%)明显高于硬镜上部组(70.8%),软镜下部组(95.2%)与硬镜下部组(90.9%)比较无统计学差异(P>0.05)。两组手术成功患者手术时间比较:整体及分亚组比较,软镜组均明显长于硬镜组(P均<0.05)。两组严重并发症比较:整体及分亚组比较,软镜组与硬镜组差异均无统计学意义(P>0.05)。两组1个月结石清除率比较:整体上软镜组(84.1%)与硬镜组(67.6%)差异无统计学意义(P>0.05);分亚组比较,软镜上部组(83.3%)明显高于硬镜上部组(52.9%),软镜下部组(85.0%)与硬镜下部组(80.0%)无统计学差异(P>0.05)。两组3个月结石清除率比较:整体及分亚组比较,软镜组与硬镜组均无统计学差异(P>0.05)。结论:输尿管软镜与输尿管硬镜钬激光碎石术均为相对安全的手术方式。对于肾下极水平以上的输尿管上段结石,软镜钬激光碎石术的手术成功率和1个月结石清除率高于输尿管硬镜联合拦截网篮碎石术,是该部位更优的手术方式。对于肾下极以下的输尿管上段结石,软镜碎石和硬镜联合拦截网篮碎石的手术效果无明显差异,但硬镜手术时间更短。

Objective:To analyze the clinical efficacy of flexible ureteroscopic holmium laser lithotripsy(FURL)and rigid ureteroscopic holmium laser lithotripsy(RURL)with N-Trap in the treatment of upper ureteral calculi.Methods:A total of 92 cases of upper ureteral calculi with a diameter greater than 10 mm admitted to Shanghai TCM-Integrated Hospital,Shanghai University of Traditional Chinese Medicine from October 2021 to April 2023 were selected as research subjects.The cases were randomly divided into FURL group of 46 cases and RURL group of 46 cases.The FURL group received the operation of FURL,while the RURL group received the operation of RURL with N-Trap.The operation success rate between FURL group and RURL group were compared.The surgical time,severe complications,1-month stone clearance rate and 3-month stone clearance rate of the successful operation cases between the FURL group and the RURL group were compared.After dividing the two groups of calculi cases into upper FURL group,lower FURL group,and upper RURL group,lower RURL group based on whether the calculus was above the lower pole of the kidney or not,the indexes mentioned above were compared between the two groups in subgroups.Results:The operation success rate of the FURL group(95.7%)was significantly higher than that of the RURL group(80.4%).The operation success rate of the upper FURL group(96.0%)was significantly higher than that of the upper RURL group(70.8%),while there was no significant difference between the lower FURL group(95.2%)and the lower RURL group(90.9%,P>0.05).The indexes of the successful operation cases of the two groups were analyzed as follows.The operation duration of the FURL group,the upper FURL group,and the lower FURL group were longer than those of the RURL group,the upper RURL group,and the lower RURL group respectively(P<0.05).There were no significant differences in the incidence of severe complications between the FURL group,the upper FURL group,the lower FURL group and the RURL group,the upper RURL group,the lower RURL group respectively(P>0.05).There was no significant difference in 1-month stone clearance rate between the FURL group(84.1%)and the RURL group(67.6%,P>0.05).The 1-month stone clearance rate of the upper FURL group(83.3%)was higher than that of the upper RURL group(52.9%),while there was no significant difference in 1-month stone clearance rate between the lower FURL group(85.0%)and the lower RURL group(80.0%,P>0.05).There were no significant differences in 3-month stone clearance rate between the FURL group,the upper FURL group,the lower FURL group and the RURL group,the upper RURL group,the lower RURL group respectively(P>0.05).Conclusion:Both FURL and RURL are safe operations in the treatment of upper ureteral calculi.For the upper ureteral calculi above the lower renal pole,the success rate and 1-month stone clearance rate are higher with the treatment of FURL than those with the treatment of RURL,it may be implicated that FURL is a better choice than RURL in the treatment of calculi in this segment of upper ureter.For the upper ureteral calculi below the lower renal pole,the success rate and stone clearance rate are similar between FURL and RURL,while the operation time of RURL is shorter than that of FURL.