Occlusion device combined with rigid ureteroscopy and flexible ureteroscopy in the treatment of upper ureteral stones
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摘要: 目的 探讨封堵器联合输尿管硬镜和输尿管软镜在输尿管上段结石治疗中的安全性及有效性。方法 对安徽医科大学附属巢湖医院2021年1月-2023年1月收治的43例上段输尿管结石患者进行回顾性分析，根据手术方式分为A、B 2组。A组使用一次性内镜下取石导管作为封堵器联合输尿管硬镜碎石，共23例；B组为未封堵或封堵失败，Ⅰ期或者Ⅱ期使用输尿管软镜碎石，共20例。统计2组患者的结石清除率、手术时间、住院时间、总花费、术后并发症发生率。结果 A组手术时间为(40.87±17.23)min，B组为(111.85±31.57)min；A组住院费用为(11 603.08±1 013.68)元，低于B组的(22 033.63±3 268.94)元。A组住院天数为(4.04±0.77)d，B组为(8.95±2.74)d。以上指标均差异有统计学意义(P < 0.05)。A组术后1个月结石清除率为91.30%，B组为95.00%，差异无统计学意义(P>0.05)。2组的术后并发症发生率差异无统计学意义(P>0.05)。结论 一次性内镜下取石导管作为封堵器用于治疗输尿管上段结石疗效确切，安全性较高，且可降低手术费用，减少患者的花费，有利于DRG模式下的费用控制。Abstract: Objective To investigate the safety and effectiveness of occluder combined with rigid ureteroscope and flexible ureteroscope in the treatment of upper ureteral stones.Methods A retrospective analysis was performed on 43 patients with upper ureteral calculi admitted to our hospital from January 2021 to January 2023. Group A consisted of 23 patients who were treated with occluder combined with rigid ureteroscopy. Group B consisted of 20 patients who were unblocked or failed to be blocked, and flexible ureteroscopic lithotripsy was used in stage Ⅰ or stage Ⅱ. The patient's stone clearance rate, surgical time, hospital stay, total expenses, and incidence of postoperative complications were calculated.Results The operation time of group A was (40.87±17.23) minutes; the operation time of group B was (111.85±31.57) minutes. The total cost of group A was (11 603.08±1 013.68) Yuan, lower than that of group B (22 033.63±3 268.94) Yuan. The hospitalization days of group A were (4.04±0.77)days, and the hospitalization days of group B were (8.95±2.74) days. The above differences were statistically significant(P < 0.05). One month after operation, the stone-free rate was 91.30% in group A and 95.00% in group B, and there was no statistical significance(P>0.05). Also, there was no significant difference in postoperative complications between the two groups(P>0.05).Conclusion The use of a disposable endoscopic lithotomy catheter for the treatment of upper ureteral calculi is effective, safe, and can reduce surgical costs and patient expenses, which is beneficial for cost control in DRG mode.
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Key words:
- occluder /
- upper ureteral calculi /
- ureteroscopy
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表 1 2组患者基本资料比较
例，X ± s 组别 例数 性别 年龄/岁 患侧 肾积水 男 女 左 右 轻度 中度 A组 23 16 7 50.04±12.18 14 9 13 10 B组 20 15 5 50.25±15.04 14 6 13 7 χ2/t 0.16 -0.05 0.40 0.32 P值 0.70 0.96 0.53 0.57 
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表 2 2组患者围手术期情况比较
X ± s 指标 A组 B组 P值 手术时长/min 40.87±17.23 111.85±31.57 <0.05 结石大小/mm 9.70±3.98 14.25±3.23 <0.05 距肾盂距离/mm 3.26±2.40 0.40±0.88 <0.05 住院时间/d 4.04±0.77 8.95±2.74 <0.05 总费用/元 11 603.08± 1 013.68 22 033.63± 3 268.94 <0.05 术后1个月结石清除率/% 91.30 95.00 0.64
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表 3 2组患者术后并发症发生率比较
例(%) 组别 血尿 感染 石街 A组(23例) 1(4.35) 1(4.35) 2(8.70) B组(20例) 1(5.00) 1(5.00) 1(5.00) P值 0.92 0.92 0.64
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