侧卧体位下输尿管镜气压弹道与钬激光治疗输尿管中上段嵌顿性结石并息肉的疗效比较
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摘要
目的了解侧卧体位下输尿管镜气压弹道与钬激光治疗输尿管中上段嵌顿性结石并息肉的临床疗效差异。方法回顾性分析进行钬激光治疗的45例和接受气压弹道治疗的45例输尿管中上段嵌顿性结石并息肉患者,比较2组患者临床指标(手术时间、碎石时间、术后住院时间、尿液转清时间、术中出血量)、碎石情况(碎石成功率、碎石排尽率、结石残留率)、并发症发生情况。结果 2组患者治疗前基本资料构成差异均无统计学意义(P>0.05)。2组患者手术情况比较,手术时间(t=7.482,P=0.000)、碎石时间(t=7.364,P=0.000)、术后住院时间(t=9.092,P=0.000)、尿液转清时间(t=7.028,P=0.000)、术后出血量(t=18.255,P=0.000)差异均有统计学意义(P<0.05);2组患者碎石成功率(χ2=5.294,P=0.021)和排尽率(χ2=3.873,P=0.049)差异均有统计学意义(P<0.05);钬激光组患者并发症发生率(6.67%)小于气压弹道组(20.00%);术后1年和2年随访,钬激光组结石复发率均小于气压弹道组(P<0.05)。结论钬激光相比输尿管镜气压弹道治疗技术,对于输尿管中、上段嵌顿性结石合并息肉的临床治疗效果更好,能提升碎石成功率和排尽率,减少并发症的发生和结石复发率。
Objective To observe and compare the therapeutic effects between ureterorenoscopic air pressure ballistic therapy and holmium laser therapy on incarcerated stone with polyp in upper and middle parts of ureter under side-lying position. Methods The clinical data about 90 patients incarcerated stone with polyp in upper and middle parts of ureter who were treated in our hospital were retrospectively analyzed,in whom,45 patients were treated by ureterorenoscopic air pressure ballistic therapy( air pressure ballistic treatment group),however,the other 45 patients were treated by holmium laser therapy( holmium laser treatment group). The clinical indexes including operation time,lithotrity time,hospitalization time after operation,the time of urine becoming limpidity and intraoperative bleeding volume,lithotrity status including the success rate of lithotrity,evacuation rate of calculi and calculi residual rate,incidence rate of complications were observed and compared between the two groups. Results Before treatment there was no significant difference in basic information between two groups( P > 0. 05),and the data had comparability. There were significant differences in operation time,lithotrity time,lithotrity time,hospitalization time after operation,the time of urine becoming limpidity and postoperative bleeding volume between two groups( P < 0. 01). Moreover there were significant differences in success rate of lithotrity and exhaustion rate of calculi between two groups( P < 0. 05). Moreover the incidence rate of complications was 6. 67% in holmium laser treatment group,which was significantly lower than that( 20. 00%) in air pressure ballistic treatment group( P < 0. 05). After 1-year and 2-year follow up,the relapse rate in holmium laser treatment group was obviously lower than that in air pressure ballistic treatment group( P < 0. 05). Conclusion The holmium laser therapy has better therapeutic effects on incarcerated stone with polyp in upper and middle parts of ureter,as compared with those by ureterorenoscopic air pressure ballistic therapy,which can improve the success rate of lithotrity and exhaustion rate of calculi,and can decrease the incidence rate of complications and calculi relapse rate.
Objective To observe and compare the therapeutic effects between ureterorenoscopic air pressure ballistic therapy and holmium laser therapy on incarcerated stone with polyp in upper and middle parts of ureter under side-lying position. Methods The clinical data about 90 patients incarcerated stone with polyp in upper and middle parts of ureter who were treated in our hospital were retrospectively analyzed,in whom,45 patients were treated by ureterorenoscopic air pressure ballistic therapy( air pressure ballistic treatment group),however,the other 45 patients were treated by holmium laser therapy( holmium laser treatment group). The clinical indexes including operation time,lithotrity time,hospitalization time after operation,the time of urine becoming limpidity and intraoperative bleeding volume,lithotrity status including the success rate of lithotrity,evacuation rate of calculi and calculi residual rate,incidence rate of complications were observed and compared between the two groups. Results Before treatment there was no significant difference in basic information between two groups( P > 0. 05),and the data had comparability. There were significant differences in operation time,lithotrity time,lithotrity time,hospitalization time after operation,the time of urine becoming limpidity and postoperative bleeding volume between two groups( P < 0. 01). Moreover there were significant differences in success rate of lithotrity and exhaustion rate of calculi between two groups( P < 0. 05). Moreover the incidence rate of complications was 6. 67% in holmium laser treatment group,which was significantly lower than that( 20. 00%) in air pressure ballistic treatment group( P < 0. 05). After 1-year and 2-year follow up,the relapse rate in holmium laser treatment group was obviously lower than that in air pressure ballistic treatment group( P < 0. 05). Conclusion The holmium laser therapy has better therapeutic effects on incarcerated stone with polyp in upper and middle parts of ureter,as compared with those by ureterorenoscopic air pressure ballistic therapy,which can improve the success rate of lithotrity and exhaustion rate of calculi,and can decrease the incidence rate of complications and calculi relapse rate.
引文
1连乐林,张育周.输尿管镜气压弹道碎石术与后腹腔镜输尿管切开取石术治疗输尿管上段结石疗效比较.中国医学创新,2017,14:68-71.
2 樊江勇,范启腾,唐咸军,等.输尿管下段结石气压弹道碎石术术后留置内外支架管的对比研究.现代泌尿外科杂志,2017,22:22-24.
3 蒋其龙,胡自力,刘川,等.新型探针和N-Trap阻石篮治疗上段输尿管结石的对比研究.重庆医学,2016,45:3916-3918,3921.
4 蒋育斌.体外冲击波碎石术与输尿管镜气压弹道碎石术治疗输尿管结石的效果对比.包头医学院学报,2016,32:71-72.
5 章庆华,林谦,宋正尧,等.钬激光碎石术治疗输尿管上段嵌顿结石患者感染的分析.中华医院感染学杂志,2016,26:2814-2816.
6 蒋其龙.新型探针和N-Trap阻石篮在输尿管镜下气压弹道碎石治疗上段输尿管结石的对比研究.重庆医科大学,2016.
7 朱清,姜红芬,马菊,等.输尿管上段嵌顿结石合并感染的病原菌分析与治疗.中华医院感染学杂志,2016,26:2311-2313.
8 刘亚东,田河,安瑞华.经尿道输尿管镜气压弹道碎石治疗单发输尿管结石后发生输尿管狭窄的危险因素分析.现代泌尿外科杂志,2016,21:252-255.
9 徐遵礼,石格荣,朱建平,等.输尿管镜碎石术治疗老年输尿管结石112 例.西北国防医学杂志,2016,23:150-152.
10 成俊,郭小鹏,王鹏.输尿管镜钬激光碎石术治疗老年输尿管结石的疗效及对肾功能的影响.中国老年学杂志,2016,36:683-685.
11 黄小清,韩小云,洪涛,等.间断负压吸引在输尿管镜下输尿管碎石术的应用及护理配合.江苏医药,2015,41:2903-2904.
12 耿新龙.两种术式治疗输尿管上段结石的疗效比较.山西职工医学院学报,2015,25:33-34.
13 裴向克,姜伟,刘彦斌,等.局麻下输尿管镜气压弹道碎石治疗输尿管中下段结石46例.临床军医杂志,2015,43:840-842.
14 韦艳梅.输尿管镜气压弹道碎石术治疗输尿管结石的效果分析.现代诊断与治疗,2015,26:4894-4895.
15 钟煜铧,刘继普,郑永宏.MPCNL与URL治疗输尿管上段结石的疗效及安全性比较.临床军医杂志,2015,43:784-786.
16 任小强.输尿管镜气压弹道碎石术治疗输尿管结石的临床效果探析.河南医学研究,2015,24:107-108.
17 张春宇,罗功唐,杨金强,等.改良输尿管镜气压弹道碎石术治疗输尿管结石的技巧探讨.河北医药,2014,36:1980-1982.
18 庄红雨,彭涛,许学敏.输尿管镜气压弹道碎石术治疗输尿管结石(附1180例报告).中国微创外科杂志,2014,27:426-429.
19 程洪林,郭闯,李旭明,等.输尿管镜气压弹道碎石术与微创经皮肾镜取石术治疗输尿管上段嵌顿结石合并感染的对比研究.重庆医学,2014,43:442-444.
2 樊江勇,范启腾,唐咸军,等.输尿管下段结石气压弹道碎石术术后留置内外支架管的对比研究.现代泌尿外科杂志,2017,22:22-24.
3 蒋其龙,胡自力,刘川,等.新型探针和N-Trap阻石篮治疗上段输尿管结石的对比研究.重庆医学,2016,45:3916-3918,3921.
4 蒋育斌.体外冲击波碎石术与输尿管镜气压弹道碎石术治疗输尿管结石的效果对比.包头医学院学报,2016,32:71-72.
5 章庆华,林谦,宋正尧,等.钬激光碎石术治疗输尿管上段嵌顿结石患者感染的分析.中华医院感染学杂志,2016,26:2814-2816.
6 蒋其龙.新型探针和N-Trap阻石篮在输尿管镜下气压弹道碎石治疗上段输尿管结石的对比研究.重庆医科大学,2016.
7 朱清,姜红芬,马菊,等.输尿管上段嵌顿结石合并感染的病原菌分析与治疗.中华医院感染学杂志,2016,26:2311-2313.
8 刘亚东,田河,安瑞华.经尿道输尿管镜气压弹道碎石治疗单发输尿管结石后发生输尿管狭窄的危险因素分析.现代泌尿外科杂志,2016,21:252-255.
9 徐遵礼,石格荣,朱建平,等.输尿管镜碎石术治疗老年输尿管结石112 例.西北国防医学杂志,2016,23:150-152.
10 成俊,郭小鹏,王鹏.输尿管镜钬激光碎石术治疗老年输尿管结石的疗效及对肾功能的影响.中国老年学杂志,2016,36:683-685.
11 黄小清,韩小云,洪涛,等.间断负压吸引在输尿管镜下输尿管碎石术的应用及护理配合.江苏医药,2015,41:2903-2904.
12 耿新龙.两种术式治疗输尿管上段结石的疗效比较.山西职工医学院学报,2015,25:33-34.
13 裴向克,姜伟,刘彦斌,等.局麻下输尿管镜气压弹道碎石治疗输尿管中下段结石46例.临床军医杂志,2015,43:840-842.
14 韦艳梅.输尿管镜气压弹道碎石术治疗输尿管结石的效果分析.现代诊断与治疗,2015,26:4894-4895.
15 钟煜铧,刘继普,郑永宏.MPCNL与URL治疗输尿管上段结石的疗效及安全性比较.临床军医杂志,2015,43:784-786.
16 任小强.输尿管镜气压弹道碎石术治疗输尿管结石的临床效果探析.河南医学研究,2015,24:107-108.
17 张春宇,罗功唐,杨金强,等.改良输尿管镜气压弹道碎石术治疗输尿管结石的技巧探讨.河北医药,2014,36:1980-1982.
18 庄红雨,彭涛,许学敏.输尿管镜气压弹道碎石术治疗输尿管结石(附1180例报告).中国微创外科杂志,2014,27:426-429.
19 程洪林,郭闯,李旭明,等.输尿管镜气压弹道碎石术与微创经皮肾镜取石术治疗输尿管上段嵌顿结石合并感染的对比研究.重庆医学,2014,43:442-444.