细输尿管镜钬激光碎石术治疗输尿管中下段结石多中心大样本应用体会

陈少鹏; 罗力; 何祥; 赵阳; 叶钧; 却学云; 陶举堂; 黄苏宁; 宋玉堂; 杨梓光; 方紫薇; 孟年文; 李南南; 胡合营

doi:10.13201/j.issn.1001-1420.2023.12.015

细输尿管镜钬激光碎石术治疗输尿管中下段结石多中心大样本应用体会

- 1.
  正生医生集团(深圳)有限公司(广东深圳，518000)
- 2.
  浙江省余姚市邦尔医院泌尿外科
- 3.
  广州市嘉禾益民医院泌尿外科
- 4.
  江苏省盐城市大丰友义医院泌尿外科
- 5.
  浙江省仙居县邦尔医院泌尿外科
- 6.
  广州市新市医院泌尿外科
- 7.
  浙江省嘉善县姚庄医院泌尿外科
- 8.
  广东省兴宁市鸿惠医院泌尿外科
- 9.
  浙江省乐清市友义医院泌尿外科
- 10.
  广东省深圳市华侨医院泌尿外科
- 11.
  江苏省滨海县康达医院泌尿外科
- 12.
  广东省佛山市三水区同方芦苞医院泌尿外科

详细信息

通讯作者: 陈少鹏，E-mail: 274739518@qq.com

中图分类号: R693

收稿日期: 2023-04-16

刊出日期: 2023-12-06

Experience of fine ureteroscopic holmium laser lithotripsy for the treatment of middle and lower ureteral calculi

- 1.
  Zhengsheng Doctor Group[Shenzhen]Co., Ltd., Shenzhen, Guangdong, 518000, China
- 2.
  Department of Urology, Banger Hospital, Yuyao City, Zhejiang Province
- 3.
  Department of Urology, Guangzhou Jiahe Yimin Hospital
- 4.
  Department of Urology, Dafeng Youyi Hospital, Yancheng City, Jiangsu Province
- 5.
  Department of Urology, Banger Hospital, Xianju County, Zhejiang Province
- 6.
  Department of Urology, Guangzhou Xinshi Hospital
- 7.
  Department of Urology, Yaozhuang Hospital, Jiashan County, Zhejiang Province
- 8.
  Department of Urology, Honghui Hospital, Xingning City, Guangdong Province
- 9.
  Department of Urology, Youyi Hospital, Yueqing City, Zhejiang Province
- 10.
  Department of Urology, Shenzhen Overseas Chinese Hospital, Guangdong Province
- 11.
  Department of Urology, Kangda Hospital, Binhai County, Jiangsu Province
- 12.
  Department of Urology, Tongfang Lubao Hospital, Sanshui District, Foshan City, Guangdong Province

More Information

Corresponding author: CHEN Shaopeng, E-mail: 274739518@qq.com

Received Date: 16 April 2023

Publish Date: 06 December 2023

摘要

摘要: 目的评价细输尿管镜治疗输尿管中下段结石的应用效果。方法本研究采用前瞻性、多中心进行，选取2021年10月—2022年9月正生医生集团多个临床中心收治的1 298例输尿管中下段结石患者资料，分为细输尿管镜组(试验组)和标准输尿管镜组(对照组)，其中试验组708例行细输尿管镜联合钬激光碎石治疗，对照组590例行标准输尿管镜钬激光碎石治疗，就2组的临床资料进行对比。结果 2组患者一般资料比较差异均无统计学意义(P>0.05)；但术中上镜成功率、上镜难易程度、黏膜损伤程度、手术时间等方面，试验组应用效果均明显优于对照组(P < 0.05)，2组碎石取石效果和并发症比较差异无统计学意义(P>0.05)。结论应用细输尿管镜钬激光治疗输尿管中下段结石碎石成功率高，损伤小且轻，尤其适用于输尿管结石较小的情况，术后疼痛轻，恢复快，且同时有更高的安全性，应用价值十分突出，细输尿管镜可作为输尿管中下段结石治疗优先选择的器械。
- 输尿管结石 /
- 输尿管镜 /
- 多中心研究
Abstract: Objective To evaluate the efficacy of fine ureteroscopy in the treatment of middle and lower ureteral calculi.Methods This study was a prospective and multicenter study. From October 2021 to September 2022, 1 298 patients with middle and lower ureteral calculi admitted to multiple clinical centers of Zhengsheng Doctor Group were selected and divided into the fine ureteroscope group (experimental group) and the standard ureteroscope group (control group). Seven hundred and eight cases underwent fine ureteroscopy combined with holmium laser lithotripsy and 590 cases underwent standard ureteroscopy with holmium laser lithotripsy. The clinical data of the two groups were compared.Results There was no significant difference in general data between the two groups(P>0.05). However, the success rate of ureteroscopy insertion, the difficulty degree of ureteroscopy insertion, the degree of mucosal injury, and the operation time of the fine ureteroscope group were significantly better than those of the standard ureteroscope group(P < 0.05). There was no significant difference in the effect of lithotripsy or complications between the two groups(P>0.05).Conclusion The application of fine ureteroscopy holmium laser in the treatment of middle and lower ureteral calculi has a high success rate of lithotripsy, small and light damage, and is especially suitable for the case of small ureteral calculi. The application value is very prominent for its less postoperative pain, quick recovery, and higher safety, so it can be used as the preferred instrument for the treatment of middle and lower ureteral calculi.
- ureteral calculi /
- ureteroscopy /
- multi-center study

HTML全文

表 1 2组患者一般资料比较例，X±S

组别	例数	性别		年龄/岁	结石最大径/mm	结石部位		左右分侧
组别	例数	男	女	年龄/岁	结石最大径/mm	中	下	左侧	右侧
试验组	708	516	192	45.68±13.36	8.023±1.767	142	566	369	339
对照组	590	438	152	45.37±13.40	7.956±1.623	121	469	308	282
t/χ²		0.219		1.921	6.592	0.041		0.001
P值		0.640		0.681	0.483	0.840		0.976

下载: 导出CSV

表 2 2组患者术中资料比较例，X±S

组别	例数	是否成功上镜		上镜难易程度			黏膜损伤程度			碎石取石效果			其他并发症	手术时间/min
组别	例数	是	否	易	中	难	轻	中	重	好	中	差	其他并发症	手术时间/min
试验组	708	704	4	502	198	8	607	101	0	619	95	4	4	22.84±11.09
对照组	590	571	19	349	216	25	432	155	3	526	61	3	6	24.17±11.94
t/χ²		13.037		26.540			33.415			3.710			0.860	-2.077
P值		<0.001		<0.001			<0.001			0.156			0.354	0.038

下载: 导出CSV

参考文献(20)

[1]	那彦群, 叶章群, 孙颖浩. 中国泌尿外科疾病诊断治疗指南: 2014版[M]. 北京: 人民卫生出版社, 2013: 269-271.
[2]	Preminger GM, Tiselius HG, Assimos DG, et al. 2007 guideline for the management of ureteral calculi[J]. Eur Urol, 2007, 52(6): 1610-1631. doi: 10.1016/j.eururo.2007.09.039
[3]	付猛, 胡卫国, 李建兴. 输尿管镜碎石取石术安全共识[J]. 现代泌尿外科杂志, 2020, 25(5): 385-391.
[4]	鲁斌, 杨龙宝, 赵伟, 等. 输尿管结石行输尿管镜下钬激光碎石治疗的临床效果分析[J]. 当代医学, 2021, 27(3): 9-11.
[5]	员海超, 王燕, 胡祎民, 等. 负压吸引鞘碎石治疗嵌顿性输尿管结石的疗效及安全性评估[J]. 临床外科杂志, 2022, 30(2): 118-120. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWK202202005.htm
[6]	Rohith G, Nayak P. Re: ranan dasgupta, sarah Cameron, lorna aucott, et al. shockwave lithotripsy versus ureteroscopic treatment as therapeutic interventions for stones of the ureter(TISU): a multicentre randomised controlled non-inferiority trial. eur urol 2021;80: 46-54[J]. Eur Urol, 2021, 80(5): e119. doi: 10.1016/j.eururo.2021.08.021
[7]	骆八强, 陶志兴, 孙大开. 输尿管镜钬激光结合输尿管切开术在输尿管中下段结石伴输尿管开口狭窄治疗中的应用[J]. 临床医药文献电子杂志, 2019, 6(72): 19, 23. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWX201972014.htm
[8]	林俊, 王坚, 米华. 输尿管镜钬激光碎石术中输尿管损伤的因素分析[J]. 微创医学, 2019, 14(4): 452-455. https://www.cnki.com.cn/Article/CJFDTOTAL-WCYX201904017.htm
[9]	de Coninck V, Keller EX, Somani B, et al. Complications of ureteroscopy: a complete overview[J]. World J Urol, 2020, 38(9): 2147-2166.
[10]	Whitehurst LA, Somani BK. Semi-rigid ureteroscopy: indications, tips, and tricks[J]. Urolithiasis, 2018, 46(1): 39-45.
[11]	赵纪宇, 张军, 刘佳, 等. 一期细输尿管镜钬激光碎石治疗标准输尿管镜上行困难的输尿管结石[J]. 中国激光医学杂志, 2021, 30(1): 30. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJG202101057.htm
[12]	Bhaskarapprakash AR, Karri L, Velmurugan P, et al. Ureteral avulsion during semirigid ureteroscopy: a single-centre experience[J]. Surg Res Pract, 2020, 2020: 3198689.
[13]	李林锦, 朱建龙, 鲍文朔, 等. 输尿管下段小结石输尿管镜下低能量中频率钬激光碎石术后双J管早期拔除的可行性探讨[J]. 浙江创伤外科, 2015, 20(4): 708-709.
[14]	Fried NM, Irby PB. Advances in laser technology and fibre-optic delivery systems in lithotripsy[J]. Nat Rev Urol, 2018, 15(9): 563-573.
[15]	龚宾宾, 宋正尧, 徐雨辰, 等. 6.0/7.5 F输尿管镜联合200 μm光纤在治疗输尿管中下段结石中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(6): 507-510.
[16]	秦远, 唐龙龙, 杨明, 等. F6.0/7.5输尿管镜下钬激光碎石术治疗输尿管结石的临床疗效[J]. 江苏医药, 2019, 45(12): 1239-1242. https://www.cnki.com.cn/Article/CJFDTOTAL-YIYA201912015.htm
[17]	杨益民, 陈志阳. 细输尿管镜钬激光碎石治疗输尿管结石的临床效果[J]. 中国当代医药, 2016, 23(22): 64-66.
[18]	Söylemez H, Yıldırım K, Utangac MM, et al. A new alternative for difficult ureter in adult patients: No need to dilate ureter via a balloon or a stent with the aid of 4.5F semirigid ureteroscope[J]. J Endourol, 2016, 30(6): 650-654.
[19]	李超文, 黄勇平, 黄华武, 等. 小儿输尿管镜联合钬激光治疗成人输尿管结石合并同侧肾上盏结石的临床效果[J]. 广西医学, 2019, 41(18): 2284-2287.
[20]	Omar M, Dorrah M, Khalifa A, et al. Randomized comparison of 4.5/6 Fr versus 6/7.5 Fr ureteroscopes for laser lithotripsy of lower/middle ureteral calculi: towards optimization of efficacy and safety of semirigid ureteroscopy[J]. World J Urol, 2022, 40(12): 3075-3081.