负压组合式硬管镜联合输尿管软镜钬激光碎石术治疗直径>20 mm无积水上尿路结石的疗效分析

Efficacy of Joint Application of Combinatorial Rigid Tube Mirror and Flexible Ureteroscope Holmium Laser Lithotripsy to Treat Non-Hydronephrosis Patients with Upper Urinary Calculi of a Diameter >20mm

目的探讨负压组合式硬管镜联合输尿管软镜钬激光碎石治疗直径>20 mm无积水上尿路结石的疗效和安全性。方法回顾性分析2016年1月至2017年12月,应用无积水上尿路结石直径>20 mm患者100例的临床资料,将患者分为两组。实验组(A组),患者50例,采用负压组合式硬管镜联合输尿管软镜钬激光碎石治疗,激光治疗功率0. 8~1. 0 W,频率10~15 Hz;对照组(B组),患者50例,同期行微创经皮肾镜碎石治疗。所有患者术后第1天复查血常规及肾功能,第3天及2周后均复查KUB,记录两组患者的血红蛋白下降量、平均碎石时间、一二期清石率、住院时间和并发症等指标,并进行比较分析。结果 A组碎石时间长于B组,一期清石率低于B组,差异均有统计学意义(P<0. 05);A组平均血红蛋白下降量明显少于B组,住院时间短于B组,差异均具有统计学意义(P<0. 05);两组患者二期清石率和术后血肌酐比较,差异无统计学意义(P>0. 05);B组并发症发生率高于A组,差异具有统计学意义(P<0. 05);两组患者无一例出现腹腔脏器损伤和感染性休克。结论负压组合镜联合软镜处理无积水上尿路结石并发症少、恢复快,针对结石直径≤20 mm的上尿路结石治疗,建议优先选用此方法。对于上尿路结石直径>20 mm者,组合镜及软镜钬激光碎石术可作为微创经皮肾镜碎石的一种替代治疗,推荐分期手术。

Objective To evaluate the clinical efficacy and safety of the combined application of combinatorial rigid tube mirror and flexible ureteroscope holmium laser lithotripsy to treat non-hydronephrosis patients with upper urinary calculi of a diameter>20 mm.Methods Totally 100 non-hydronephrosis patients with upper urinary calculi of a diameter>20 mm admitted to our department from Jan.2016 to Dec.2017 were selected for the study.They were divided into Group A and B,each with 50 patients.The patients in Group A,i.e.the experimental group,were given the lithotripsy based on the combination of combinatorial rigid tube mirror and flexible ureteroscope,and those in Group B,i.e.the control group,minimally invasive percutanous nephrolithotripsy.The blood routine and renal function were reexamined on the first day after operation and KUB was reexamined on the third day and two weeks after operation.The clinical data of hemoglobin decline,average time of macadam,stone clearing rate of StageⅠorⅡ,time of hospitalization and complications of all the patients were retrospectively analyzed.Results The lithotripsy time of Group A was longer than that of Group B,the Stage I stone clearing rate of Group A is lower than that of Group B,and the differences were statistically significant(P<0.05).The average decrease of hemoglobin in Group A was significantly less than that in group B,the hospitalization time of Group A was shorter than that of Group B,and the differences were statistically significant(P<0.05).There was no significant difference between the two groups in Stage II stone clearing rate and postoperative blood creatinine(P>0.05).The incidence of complications in Group B was higher than that in Group A,and the difference was statistically significant(P<0.05).Neither abdominal visceral injury nor infectious shock occurred in either group.Conclusion For non-hydronephrosis patients with upper urinary calculi of a diameter≤20 mm,the combined application of combinatorial rigid tube mirror and flexible ureteroscope should be a preferred choice due to less complications and faster recovery.As to non-hydronephrosis patients with upper urinary calculi of a diameter>20 mm,the combination of combinatorial rigid tube mirror and flexible ureteroscope can be used as an alternative treatment for minimally invasive percutaneous nephrolithotripsy and conducted by stages for recommendation.