阻石网篮联合输尿管镜钬激光碎石术治疗输尿管中上段结石的临床观察

Clinical observation of stone-resistance basket combined with ureteroscopic holmium laser lithotripsy in the treatment of upper and middle ureteral stones

目的:探究阻石网篮在输尿管镜钬激光碎石术治疗输尿管中上段结石的效率及输尿管狭窄的发生率。方法:2019年1月—2020年12月经武汉市东西湖区人民医院泌尿外科及武汉大学人民医院泌尿外科收治的104例输尿管结石患者纳做本次研究对象,采用随机对照法,分为联合组(n=52)和单一组(n=52),联合组采用阻石网篮联合输尿管镜钬激光碎石术治疗,单一组采用输尿管镜钬激光碎石术治疗,比较两组首次碎石成功率、手术时间、术后肾积水情况变化和术后输尿管狭窄发生情况、肾功能变化(血肌酐、血尿素氮)。结果:联合组首次碎石成功率高于单一组(P<0.05);联合组手术时间短于单一组(P<0.05);两组术后3、6、12个月肾积水程度均呈逐渐下降趋势,但联合组术后3、6、12个月肾积水缓解情况优于单一组,差异有统计学意义(P<0.05);术后随访12个月,联合组术后发生输尿管狭窄4例,其中上段2例,中段2例,单一组术后发生上段输尿管狭窄1例,联合组术后输尿管狭窄发生率高于单一组,但差异无统计学意义(P>0.05);两组经治疗后血肌酐、血尿素氮水平均有显著下降(P<0.05),但联合组血肌酐和血尿素氮水平低于单一组(P<0.05)。结论:阻石网篮联合输尿管镜钬激光碎石术治疗输尿管中上段结石具有较高的手术效率,能够增加手术成功率,缩短手术时间,加快肾功能恢复,但在一定程度上会加大术后输尿管狭窄的发生风险,因此术后应按时随访,及早干预输尿管狭窄。

Objective:To investigate the efficiency of the stone-resistance basket in ureteroscopic holmium laser lithotripsy for upper and middle ureteral stones and the incidence of ureteral stenosis.Methods:A total of 104 patients with ureteral calculi who were treated in the Department of Urology,Dongxihu District People's Hospital of Wuhan,and the Department of Urology,Renmin Hospital of Wuhan University from January 2019 to December 2020 were included in this study.They were divided into a combined treatment group(n=52)and a single treatment group(n=52)randomly.The combined group was treated with a stone-blocking mesh basket combined with ureteroscopic holmium laser lithotripsy,and the single group was treated with ureteroscopic holmium laser lithotripsy.The first lithotripsy success rate,operation time,postoperative hydronephrosis and postoperative complications were compared between the two groups.The occurrence of posterior ureteral stricture and changes in renal function(such as serum creatinine and blood urea nitrogen)were recorded and compared.Results:The success rate of the first lithotripsy in the combined group was higher than that in the single group(P<0.05),and the operation time in the combined group was shorter(P<0.05);the degree of hydronephrosis in both groups showed a gradual downward trend in 3,6,and 12 months after the operation,but the relief of hydronephrosis in the combined group was better than that in the single group in 3,6,and 12 months after the operation,and the difference was statistically significant(P<0.05);after 12 months of follow-up,there were 4 cases of postoperative ureteral stenosis in the combination group,including 2 cases in the upper segment and 2 cases in the middle segment.The incidence rate was higher than that of the single group,but no significant difference was found between the two groups(P>0.05).After treatment,the levels of serum creatinine and blood urea nitrogen in the two groups were significantly decreased(P<0.05),but the levels of serum creatinine and blood urea nitrogen in the combined group were lower than those in the single group(P<0.05).Conclusion:Stone-resistance basket combined with ureteroscopic holmium laser lithotripsy in the treatment of middle and upper ureteral calculi can increase the success rate of surgery,shorten the operation time,and speed up the recovery of renal function,but it will increase the risk of postoperative ureteral stricture to a certain extent.So timely follow-up after operation is important,and the occurrence of ureteral stricture should be intervened as soon as possible.