Analysis on the safety of ureteroscopic lithotripsy after failure of extracorporeal shock wave lithotripsy for proximal ureteral calculi
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摘要: 目的:与直接行输尿管镜(URS)治疗输尿管上段结石进行比较,探讨ESWL失败后行输尿管镜补充治疗(ESWL-URS)的安全性。方法:我院2013年1月2016年6月收治输尿管上段结石并行手术治疗的患者共160例,其中直接行URS手术的患者100例(URS组),ESWL-URS治疗的患者60例(ESWL-URS组)。比较两组患者的成功率、手术时间、术后发热、输尿管息肉情况。结果:URS组和ESWL-URS组的成功率分别为97.0%和88.3%,ESWL-URS组较URS组所需时间长,出现术后发热的情况(15.0%)明显多于URS组(5.0%),输尿管息肉也明显多于URS组,差异均有统计学意义(P<0.05)。结论:输尿管上段结石行ESWL失败的患者行URS补充手术较直接行URS手术风险更大、手术难度更高、术后发热更容易出现。Abstract: Objective:To compare the efficacy and complication between ureteroscopic lithotripsy in proximal ureteral stones and ureteroscopic management for ureteral calculi after failure of extracorporeal shock wave lithotripsy (ESWL). Method:We analyzed data of patients with previous unsuccessful ESWL (GroupⅠ) and the ones that did not have ESWL or URS before (Group Ⅱ) for proximal ureteral stones between January 2013 and June 2016.Group I included 60 patients who underwent complementary URS and Group II 100 patients who underwent primary URS.Success rates, operation time, complications and incidence of ureteral polyps were compared between two groups.Result:Success rates of complementary and primary URS were 88.3%and 97.0%, respectively.The difference in success rates was statistically significant between two groups (χ2=4.807, P=0.041). The mean operation time between Group Ⅰ (median:45min) and Group Ⅱ (median:35min) had significant difference (Z=-4.472, P=0.000). The complication rates was statistically significant between two groups (χ2=4.697, P=0.042). Incidence of ureteral polyps were higher in complementary URS group compared to the primary URS group, and the difference was statistically significant (χ2=8.167, P=0.007). Conclusion:It is more dangerous and difficult to choose URS for proximal ureteral stones after failure of ESWL than primary URS, and patients may be more likely to experience postoperative fever.
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