“粉末法”与“碎块法”对软性输尿管镜碎石手术的预后分析

肖博; 胡卫国; 张鑫; 陈松; 唐宇哲; 付猛; 苏博兴; 刘宇保; 李建兴

doi:10.13201/j.issn.1001-1420.2018.07.004

“粉末法”与“碎块法”对软性输尿管镜碎石手术的预后分析

- 清华大学附属北京清华长庚医院泌尿外科(北京, 102218)
基金项目:
北京市医院管理局青苗计划专项经费资助(编号QML20160902)

详细信息

通讯作者: 李建兴,E-mail:ljx1@sina.com

中图分类号: R693

收稿日期: 2018-05-19

“Dusting” and “Fragmenting” method in the flexible ureteroscopy combined with laser lithotripsy

- Department of Urology, Beijing Tsinghua Changgung Hospital, Beijing, 102218, China

More Information

Corresponding author: LI Jianxing, E-mail: ljx1@sina.com

Received Date: 19 May 2018

摘要

摘要: 目的:分析2种不同碎石取石方式对软性输尿管镜结石手术的预后影响,探讨2种碎石方式的特点,明确最佳的手术方式。方法:将2015年8月~2016年12月在我院行软性输尿管镜碎石手术患者128例(肾结石<2.0cm,输尿管上段结石<1.5cm)纳入研究,其中男78例,女50例。肾结石82例,输尿管上段结石46例。患者被随机分为2组,采用“低能高频”长脉宽模式钬激光(0.4~0.6J/10~15 Hz,长脉宽)碎石患者为“粉末法”组,采用“高能低频”短脉宽模式钬激光(0.8~1.0J/5~10 Hz,短脉宽)碎石、且用网篮取出体积较大结石的患者为“碎块法”组。2组患者术后均留置支架管。对比2组患者手术时间、激光发射时间、结石清除率及术后并发症等参数。结果:2组患者均成功完成手术,其中“粉末法”组患者72例,“碎块法”组患者56例。患者平均年龄48(21~77)岁,平均结石直径1.4(0.5~2.0) cm。2组患者年龄(P=0.26)、性别(P=0.39)、结石大小(P=0.21)、钬激光功率(P=0.8)等参数比较差异无统计学意义。“碎块法”组患者激光使用时间较“粉末法”组短(P=0.029),“碎块法”组手术时间较长(P=0.02)。术后1个月复查2组残石率情况,“碎块法”组患者残石率低于“粉末法”组(P=0.018)。“粉末法”组和“碎块法”组分别有3例和2例患者出现短期发热,差异无统计学意义。2组均未出现严重并发症患者。结论:“粉末法”及“碎块法”均为软性输尿管镜碎石手术有效的手术方式,本研究发现“碎块法”激光使用时间较短,但手术时间较长,术后结石残余率较低。“粉末法”激光使用时间较长,手术时间较短,术后残石率较高。需根据结石具体情况选择合适的手术方式。
- 软性输尿管镜碎石术 /
- 钬激光 /
- 脉宽 /
- 预后
Abstract: Method:To investigate the safety and efficiency of two methods of tips in flexible ureteroscopy combined with holmium laser in treatment of upper urinary tract stones so as to define the best method during the operation.Method:From August 2015 to December 2016, 128 cases with upper urinary tract stones were enrolled into groups (renal calculi<2.0 cm, upper ureteral stone<1.5 cm).Patients were divided into two sub-groups randomly.In group "Dusting", laser mode was set with low-energy and high-frequency (0.4-0.6 J/10-15 Hz) and long pulse duration, which was called "Dusting" method.To the opposite, high-energy and low-frequency (0.8-1.0 J/5-10 Hz) and short pulse duration was applied in group "Fragmenting", which was called "Fragmenting" method.The latter also need basket to remove the fragment during the surgery.D-J stent was placed after surgery.Operation time, stone-free rate, complications were recorded.Result:The surgery was successfully completed in both two groups.Seventy-two cases were enrolled in group "Dusting", while 56 cases were enrolled into group "Fragmenting".Average age was 48 years old (range, 21-77).No significant difference was found in parameters such as age (P=0.26), gender (P=0.39), stone size (P=0.21) between the two groups.The laser emission time in group "Dusting" was much longer than group "Fragmenting" (P=0.029).The total operation time was much longer in group "Fragmenting" (P=0.02).Stone-free rate was checked after 1 month later.The residual stones were much more seen in group "Dusting" (P=0.018).Three and 2 patients experienced transient fever respectively.No severe complications happened in both the two groups.Conclusion:"Dusting" and "Fragmenting" were both effective and safe in the flexible ureteroscopy combined with laser lithotripsy.We found the "Fragmenting" method could save much more laser emission time, and residual stones were less than "Dusting".Total operation duration was shorter in "Dusting"group.However, "Dusting" method shows a lower stone-free rate.We should choose the appropriate method according to the stones.
- flexible ureteroscopic lithotripsy /
- holmium laser /
- pulse duration /
- prognosis

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参考文献(8)

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