Application of negative pressure combined with ureteroscopy in ureteral calculi with high CT value
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摘要: 目的 评估使用硕通输尿管镜治疗高CT值输尿管结石的可行性和安全性。方法 收集2020年8月—2022年11月我院单侧高CT值输尿管结石且行手术治疗的患者108例，其中行硕通输尿管镜组42例，输尿管镜组66例。所有患者在全身麻醉下完成手术，观察2组一般资料、手术时间、术后住院时间、术后1 d结石清除率、术后1个月结石清除率、Ⅰ期进镜率、Ⅱ期碎石率、术后输尿管损伤、术后发热及术后血尿发生率等。结果 2组患者一般资料、Ⅰ期进镜率、Ⅱ期碎石率、术后1个月结石清除率、术后发热等比较差异均无统计学意义(P>0.05)。硕通输尿管镜组在手术时间、术后住院天数、术后1 d结石清除率、术后血尿、输尿管损伤等方面明显优于输尿管镜组，差异有统计学意义(P < 0.05)。结论 硕通输尿管镜治疗高CT值输尿管结石安全可靠，且疗效好，具有明显优势。Abstract: Objective To evaluate the feasibility and safety of negative pressure combined with ureteroscope(SOTN) in the treatment of ureteral calculi with high CT value.Methods From August 2020 to November 2022, 108 patients with unilateral ureteral calculi with high CT value were collected and treated surgically, including 42 patients in SOTN group and 66 patients in ureteroscopy group. All patients were completed the operation under general anesthesia, and their general information, operation time, postoperative hospital stay, stone clearance rate 1 day after operation, stone clearance rate 1 month after operation, primary lens access rate, secondary lithotripsy rate, incidence of postoperative ureteral injury, postoperative fever and postoperative hematuria of the two groups were observed.Results There was no significant difference in general data, the entrance rate at stage Ⅰ, the lithotripsy rate at stage Ⅱ, the stone clearance rate one month after operation, or the postoperative fever between the SOTN and ureteroscopy groups(P>0.05). The SOTN group was significantly superior to the ureteroscope group in terms of operation time, postoperative hospital stay, stone clearance rate, postoperative hematuria, ureteral injury, etc(P < 0.05).Conclusion Negative pressure combined with ureteroscope is effective and efficient in the treatment of ureteral calculi with high CT value.
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表 1 2组输尿管结石患者一般资料比较
例(%)，X±S 项目 硕通输尿管镜组(42例) 输尿管镜组(66例) t/χ2 P值 年龄/岁 67.98±11.54 67.88±11.79 0.308 0.759 性别 0.005 0.945 男 27(64.29) 42(63.63) 女 15(35.71) 24(36.37) 结石CT值/HU 1142.48±186.27 1153.91±189.31 0.042 0.966 结石大小/cm 1.33±0.44 1.27±0.25 0.838 0.404 合并基础疾病 10(23.81) 22(33.33) 1.117 0.291 结石部位 4.704 0.100 下段 9(21.43) 21(31.82) 中段 13(30.95) 27(40.91) 上段 20(47.62) 18(27.27) 
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表 2 2组输尿管结石患者术中情况及术后并发症等指标比较
例(%)，X±S 项目 硕通输尿管镜(42例) 输尿管镜(66例) t/χ2 P值 Ⅰ期进镜率 40(95.24) 64(96.97) 0.216 0.642 Ⅱ期碎石率 2(4.76) 9(13.64) 1.148 0.284 手术时间/min 34.79±6.93 57.88±8.75 -14.459 < 0.001 术后住院天数/d 2.83±0.38 3.32±0.56 -4.945 < 0.001 术后1 d结石清除 40(95.24) 50(75.76) 11.953 0.001 术后1个月结石清除 42(100.00) 62(93.93) 2.643 0.104 血尿 5(11.90) 20(30.30) 4.884 0.027 术后发热 2(4.76) 8(12.12) 1.654 0.198 输尿管损伤 17.633 < 0.001 0级 10(23.81) 2(3.03) 1级 30(71.43) 45(68.18) 2级 2(4.76) 19(28.79)
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