Contrastive research between ureteroscope and flexible ureteroscope in the treatment of upper ureteral calculi
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摘要: 目的:通过对输尿管硬镜与输尿管软镜在治疗输尿管上段,尤其是第四腰椎横突水平以上结石手术术后结果进行比较,探讨一种输尿管导管辅助顺行灌注在输尿管硬镜治疗输尿管上段结石激光碎石中的可行性。方法:选取2016年1月—2018年1月我院诊治的102例输尿管上段结石患者,将采用输尿管导管辅助顺行灌注下输尿管硬镜下碎石患者作为研究组(n=51),将输尿管软镜下碎石术患者作为对照组(n=51)。研究组患者在行输尿管镜钬激光碎石术之前将输尿管导管插入结石上方并留置,在采用钬激光碎石时持续注水辅助顺行灌洗,对照组采用常规输尿管软镜下钬激光碎石治疗。记录两组患者手术一般情况、结石清除率、术后并发症发生率,并对评估结果进行对比分析。结果:数据显示,研究组住院费用明显低于对照组(P＜0.05),但研究组患者的结石清除率与对照组比较差异无统计学意义(92.3%vs.90.4%,P＞0.05);研究组患者的术后并发症发生率与对照组比较差异无统计学意义(32.7%vs.42.3%,P＞0.05)。结论:输尿管导管辅助顺行灌注配合输尿管镜上段结石激光碎石术治疗输尿管上段结石,在手术中能够保持手术过程中视野清晰,避免结石向上方移位,提高结石清除率,并减少术后并发症发生率,达到与输尿管软镜相似的手术效果,且住院费用更低,具有临床运用和推广意义。Abstract: Objective: To investigate the feasibility of ureteral catheter-assisted anterograde perfusion in ureteroscopic laser lithotripsy to upper ureteral calculi through the comparation of postoperative results of ureteroscope and flexible ureteroscope in treatment of upper ureteral calculi, especially the fourth lumbar level above.Methods: From January 2016 to January 2018, 102 patients with upper ureteral calculi at urology depatment in our hospital were selected as the study subjects. The patients treated by ureteroscopic laser lithotripsy of ureteral catheter-assisted anterograde perfusion were selected as study group(n=51), while the patients treated by flexible ureteroscopic laser lithotripsy were selected as control group(n=51). In study group, ureteral catheter was inserted and reserved above the calculi before ureteroscopic holmium laser lithotripsy. During holmium laser lithotripsy, continuous water injection was used to assist anterograde perfusion. In control group, operation was proceeded by routine flexible ureteroscopic holmium laser lithotripsy. The general situation of operation, calculi clearance rate and the incidence of complications were recorded. The evaluation results were compared and analyzed.Results: The data showed that the cost of hospitalization in the study group was significantly lower than that in the control group(P＜0.05), but there was no significant difference in the stone clearance rate between the study group and the control group(92.3% vs. 90.4%, P＞0.05). There was no significant difference in the incidence of postoperative complications between the study group and the control group(32.7% vs. 42.3%, P＞0.05).Conclusion: Ureteral catheter-assisted anterograde perfusion combined with ureteroscopic laser lithotripsy for upper ureteral calculi can maintain clear vision during operation, avoid upward displacement of calculi, improve stone clearance rate, and reduce the incidence of complications after operation. Its clinical efficacy is similar to flexible ureteroscopic laser lithotripsy and its hospitalization costs is less. It has clinical application and popularization significance.
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Key words:
- ureteral catheter /
- ureteroscope /
- flexible ureteroscope /
- upper ureteral calculi /
- clinical efficacy
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