输尿管镜钬激光碎石术与体外冲击波碎石术治疗输尿管上段1 cm以上结石的疗效比较
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摘要
目的探讨输尿管镜钬激光碎石术与体外冲击波碎石术(ESWL)治疗输尿管上段1 cm以上结石的疗效。方法2016年1月至2017年6月入院的300例输尿管上段1 cm以上结石患者,按随机数字表法分为两组各150例,钬激光组采用输尿管镜钬激光碎石术,ESWL组采用ESWL术,比较两组围手术期指标、并发症、炎性应激与远期预后。结果钬激光组手术时间、止痛药使用率、术后血尿时间、住院时间、总体并发症率及术后白细胞计数、白介素-6水平均低于ESWL组,总有效率及术后6个月生理功能、角色限制、身体疼痛、总体健康评分均高于ESWL组(P <0. 05)。结论输尿管镜钬激光碎石术治疗输尿管上段1 cm以上结石的疗效更为显著,安全性更高,具有推广意义。
Objective To investigate and compare the efficacy of ureteroscopic holmium laser lithotripsy with extracorporeal shock wave lithotripsy( ESWL) in the treatment of more than 1 cm of upper ureteral calculi. Methods Three hundred patients with upper ureteral calculi more than 1 cm admitted from January 2016 to June 2017 were randomly divided into holmium laser group and ESWL group,150 in each group.The holmium laser group received ureteroscopic holmium laser lithotripsy and the ESWL group received ESWL.Perioperative indexes,complications,inflammatory stress and long-term prognosis were compared between the two groups.Results The operative time,painkiller utilization rate,postoperative hematuria time,hospitalization time and overall complication rate as well as the postoperative levels of WBC and IL-6 in the holmium laser group were significantly shorter and lower than those in the ESWL group.The total effective rate,physiological function,role limitation,body pain and overall health score after 6 months of operation in the holmium laser group were higher than those in the ESWL group( P <0. 01).Conclusion Compared with ESWL,ureteroscopic holmium laser lithotripsy for more than 1 cm in the upper ureteral calculi is more effective and safer.It is of worthy for promotion.
Objective To investigate and compare the efficacy of ureteroscopic holmium laser lithotripsy with extracorporeal shock wave lithotripsy( ESWL) in the treatment of more than 1 cm of upper ureteral calculi. Methods Three hundred patients with upper ureteral calculi more than 1 cm admitted from January 2016 to June 2017 were randomly divided into holmium laser group and ESWL group,150 in each group.The holmium laser group received ureteroscopic holmium laser lithotripsy and the ESWL group received ESWL.Perioperative indexes,complications,inflammatory stress and long-term prognosis were compared between the two groups.Results The operative time,painkiller utilization rate,postoperative hematuria time,hospitalization time and overall complication rate as well as the postoperative levels of WBC and IL-6 in the holmium laser group were significantly shorter and lower than those in the ESWL group.The total effective rate,physiological function,role limitation,body pain and overall health score after 6 months of operation in the holmium laser group were higher than those in the ESWL group( P <0. 01).Conclusion Compared with ESWL,ureteroscopic holmium laser lithotripsy for more than 1 cm in the upper ureteral calculi is more effective and safer.It is of worthy for promotion.
引文
[1]施源,李宏军,李坚.肾石通颗粒配合输尿管硬镜钬激光碎石加ESWL治疗肾盂结石临床观察[J].辽宁中医药大学学报,2015,17(10):155-157.
[2]赵长永,李道兵.ESWL联合输尿管镜钬激光碎石治疗输尿管结石临床分析[J].遵义医学院学报,2016,39(5):515-517.
[3]潘杰,谢文锋,李国霞.经皮肾微造瘘输尿管镜钬激光碎石结合ESWL治疗34例复杂性肾结石临床分析[J].中国社区医师,2012,14(14):186-187.
[4]潘炜,姜永光,罗勇.钬激光治疗ESWL失败的输尿管上段结石78例分析[J].现代泌尿外科杂志,2011,16(2):120-122.
[5]Jiang JT,Li WG,Zhu YP,et al.Comparison of the Clinical Efficacy and Safety of Retroperitoneal Laparoscopic Ureterolithotomy and Ureteroscopic Holmium Laser Lithotripsy in the Treatment of Obstructive Upper Ureteral Calculi with Concurrent Urinary Tract Infections[J].Lasers Med Sci,2016,31(5):915-920.
[6]王勇,李运柱,余家俊.ESWL与输尿管镜碎石联合处理上尿路结石[J].临床泌尿外科杂志,2011,26(5):353-354.
[7]施源,李坚,鲁密.输尿管硬镜钬激光碎石联合ESWL治疗肾盂结石疗效观察[J].临床泌尿外科杂志,2016,10(7):652-653.
[8]沈欣.LL和ESWL治疗输尿管结石的疗效和安全性分析[J].承德医学院学报,2017,34(1):23-25.
[9]Cui Y,Cao W,Shen H,et al.Comparison of ESWL and Ureteroscopic Holmium Laser Lithotripsy in Management of Ureteral Stones[J].PLoS One,2014,9(2):e87634.
[10]郝继东,廖国强,刘辉.经皮肾镜钬激光碎石术与体外冲击波碎石术治疗肾结石的效果[J].河北医学,2016,22(1):20-23.
[11]赵增喜,王晶,李霞,等.体外冲击波碎石术联合经皮输尿管镜钬激光碎石术治疗老年上尿路结石患者的疗效和安全性[J].中国老年学杂志,2015,35(7):1825-1826.
[12]赵克栋.输尿管镜钬激光与体外冲击波碎石术治疗输尿管结石的疗效比较(附330例报告)[J].湖北科技学院学报:医学版,2013,27(4):310-311.
[13]Luo XM,Zhang C,Qian HJ,et al. Characteristics of Patients with Fluid Extravasation During Retrograde Ureteroscopic Holmium Laser Lithotripsy for Renal Calculi[J]. Saudi Med J,2011,32(12):1251-1255.
[14]刘定益,沈鑫源,王健,等.输尿管镜钬激光碎石与ESWL治疗输尿管下段结石疗效比较[J].中国误诊学杂志,2012,12(17):4560-4561.
[15]李强,陈红其,刘奎,等.ESWL和输尿管镜钬激光碎石治疗输尿管结石的疗效比较[J].江苏医药,2015,41(5):569-570.
[16]Zhang P,Hu WL.Sudden Onset of a Huge Subcapsular Renal Hematoma Following Minimally Invasive Ureteroscopic Holmium Laser Lithotripsy:A Case Report[J]. Exp Ther Med,2015,10(1):335-337.
[2]赵长永,李道兵.ESWL联合输尿管镜钬激光碎石治疗输尿管结石临床分析[J].遵义医学院学报,2016,39(5):515-517.
[3]潘杰,谢文锋,李国霞.经皮肾微造瘘输尿管镜钬激光碎石结合ESWL治疗34例复杂性肾结石临床分析[J].中国社区医师,2012,14(14):186-187.
[4]潘炜,姜永光,罗勇.钬激光治疗ESWL失败的输尿管上段结石78例分析[J].现代泌尿外科杂志,2011,16(2):120-122.
[5]Jiang JT,Li WG,Zhu YP,et al.Comparison of the Clinical Efficacy and Safety of Retroperitoneal Laparoscopic Ureterolithotomy and Ureteroscopic Holmium Laser Lithotripsy in the Treatment of Obstructive Upper Ureteral Calculi with Concurrent Urinary Tract Infections[J].Lasers Med Sci,2016,31(5):915-920.
[6]王勇,李运柱,余家俊.ESWL与输尿管镜碎石联合处理上尿路结石[J].临床泌尿外科杂志,2011,26(5):353-354.
[7]施源,李坚,鲁密.输尿管硬镜钬激光碎石联合ESWL治疗肾盂结石疗效观察[J].临床泌尿外科杂志,2016,10(7):652-653.
[8]沈欣.LL和ESWL治疗输尿管结石的疗效和安全性分析[J].承德医学院学报,2017,34(1):23-25.
[9]Cui Y,Cao W,Shen H,et al.Comparison of ESWL and Ureteroscopic Holmium Laser Lithotripsy in Management of Ureteral Stones[J].PLoS One,2014,9(2):e87634.
[10]郝继东,廖国强,刘辉.经皮肾镜钬激光碎石术与体外冲击波碎石术治疗肾结石的效果[J].河北医学,2016,22(1):20-23.
[11]赵增喜,王晶,李霞,等.体外冲击波碎石术联合经皮输尿管镜钬激光碎石术治疗老年上尿路结石患者的疗效和安全性[J].中国老年学杂志,2015,35(7):1825-1826.
[12]赵克栋.输尿管镜钬激光与体外冲击波碎石术治疗输尿管结石的疗效比较(附330例报告)[J].湖北科技学院学报:医学版,2013,27(4):310-311.
[13]Luo XM,Zhang C,Qian HJ,et al. Characteristics of Patients with Fluid Extravasation During Retrograde Ureteroscopic Holmium Laser Lithotripsy for Renal Calculi[J]. Saudi Med J,2011,32(12):1251-1255.
[14]刘定益,沈鑫源,王健,等.输尿管镜钬激光碎石与ESWL治疗输尿管下段结石疗效比较[J].中国误诊学杂志,2012,12(17):4560-4561.
[15]李强,陈红其,刘奎,等.ESWL和输尿管镜钬激光碎石治疗输尿管结石的疗效比较[J].江苏医药,2015,41(5):569-570.
[16]Zhang P,Hu WL.Sudden Onset of a Huge Subcapsular Renal Hematoma Following Minimally Invasive Ureteroscopic Holmium Laser Lithotripsy:A Case Report[J]. Exp Ther Med,2015,10(1):335-337.