拦截网篮和无封堵装置在治疗输尿管上段结石手术中的对比分析

Comparative study of intercepting basket and non-plugging device in the treatment of upper ureteral cal-culi in operation

目的：探讨拦截网篮在输尿管上段结石手术治疗中的应用价值。方法选取2012年12月至2015年12月我院收治的输尿管上段结石患者126例为研究对象，采用随机数字表法分为A组63例，B组63例，A组行NTrap网篮联合输尿管镜下钬激光碎石治疗，B组单行钬激光碎石治疗，未使用封堵装置。观察两组患者手术情况、术后恢复情况、治疗效果及安全性。结果 A组患者手术时间（49．56±7．45） min、术后血尿时间（1．47±0．67） d、术后住院时间（3．11±0．96） d，B组分别为（51．37±7．39） min、（1．59±0．63） d、（3．37±0．85） d，两组差异均无统计学意义（t值分别为1．369、0．518、1．609，P值分别为0．173、0．606、0．110）；A、B两组患者结石上移率分别为3．17％（2／63）、23．81％（15／63），A组明显较低，差异有统计学意义（χ2＝11．492，P＝0．000）；A组碎石成功率及术后4周清除率分别为95．24％（60／63）、98．41％（62／63），同B组74．60％（47／63）、82．54％（52／63）比较显著升高，差异有统计学意义（χ2分别为10．474、9．211，P值分别为0．001、0．002）；A、B两组患者术后并发症发生率分别为6．35％（4／63）、11．11％（7／63），两组差异无统计学意义（χ2＝0．896，P＝1．421）。结论在输尿管上段结石手术治疗中应用拦截网篮，对于预防结石及结石碎片上移有确切效果，可显著提高碎石成功率及结石清除率，值得推广。

Objective To explore the application value of intercepting basket in the treatment of upper ureteral calculi in operation. Methods One hundred and twenty?six cases patients with upper ureteral calculi who were treated in Songgang People′s Hospital of Bao′an District of Shenzhen from December 2012 to December 2015 were included and randomly divided into Group A and Group B,63 cases in each group. Group A were trea?ted with NTrap intercepting basket combined with ureteroscope holmium laser lithotripsy, while Group B were treated with holmium laser lithotripsy solely without intercepting basket. The operation situation,postoperative re?covery,therapeutic efficacy and safety of two groups were observed. Results The time of surgery,time of postop?erative hematuria and postoperative hospitalization time in Group A were (49. 56±7. 45) min,(1. 47±0. 67) d and (3. 11±0. 96) d respectively,in Group B were (51. 37±7. 39) min,(1. 59±0. 63) d and (3. 37±0. 85) d respectively,there were no significant differences in those indexes between two groups( t=1. 369,0. 518,1. 609;P=0. 173,0. 606,0. 110). The stone upward displacement rate of Group A and Group B were 3. 17%(2/63) and 23. 81%(15/63) respectively,of Group A was significantly lower and the difference was significant(χ2=11. 492,P=0. 000 ) . The gravel success rate and postoperative 4 weeks clearance rate of Group A were 95. 24%( 60/63 ) and 98. 41%( 62/63 ) respectively, significantly higher than that of Group B ( 74. 60%( 47/63) ,82. 54%( 52/63 ) ) , the difference was statistically significant (χ2 = 10. 474, 9. 211; P= 0. 001, 0. 002) . The postoperative complication rate of Group A and B were 6. 35%( 4/63) and 11. 11%( 7/63) respec?tively,there was no significant difference between the two groups(χ2=0. 896,P=1. 421) . Conclusion Appli?cation of intercepting basket in the treatment of upper ureteral calculi in operation has exact effect for the preven?tion of stone and stone upward displacement,can significantly improve the successful rate of lithotripsy and stone clearance rate,it is worthy of promotion.