输尿管封堵取石导管在输尿管上段结石中的应用
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摘要
目的探讨输尿管封堵取石导管联合钬激光碎石治疗输尿管上段结石的临床效果。方法回顾性分析2016年4月至2017年3月在我院诊断为输尿管上段结石并行输尿管镜碎石术患者病例资料,导管组采用输尿管封堵取石导管联合钬激光碎石,对照组仅采用钬激光碎石,比较两组手术效果,并采用Logistic回归分析可造成结石残留率增高的因素。结果两组患者术前情况差异无统计学意义,全部患者均完成碎石,其中导管组70例患者中58例一期成功碎石取石,12例患者术后有结石残留,有2例需体外碎石。对照组51例患者中30例一期成功碎石取石,20例患者术后有结石残留,有13例需体外碎石。两组术中术后均无严重并发症发生。结石大小、肾积水程度、输尿管扩张程度可影响碎石成功率。结论输尿管封堵取石导管联合钬激光碎石是治疗输尿管上段结石安全有效的方法,能显著减少结石移位并提高碎石成功率,输尿管扩张程度是影响碎石成功率最主要因素。
Objective To evaluate the clinical effect of the treatment of upper ureteric calculi by ureteral occlusion device combined with holmium laser lithotripsy. Methods From April 2016 to March 2017 patients diagnosed as upper ureteral calculi and underwent ureteroscopic lithotripsy in our hospital were retrospectively analyzed. The catheter group used ureteral occlusion catheter combined with holmium laser lithotripsy, the control group only used holmium laser lithotripsy. The operation effect of the two groups were compared, and Logistic analysis was used to confirm the factor of residual stone rate. Result There was no significant difference between the two groups before surgery, all patients had completed the lithotripsy. In the catheter group(70 patients), 58 cases were successfully treated with one-stage lithotripsy, no stone residue, and 12 patients had residual calculi, 2 patients required extracorporeal shock wave lithotripsy. In the control group(51 patients), 30 patients were successfully treated with one-stage lithotripsy, no stone residued, and 20 patients had residual calculi, 13 patients required extracorporeal shock wave lithotripsy. No serious complications occurred during and after the surgery in both groups.The size of calculi, the extent of hydronephrosis and the extent of ureteral dilatation can affect the success rate of lithotripsy. ConclusionUreteral occlusion catheter combined with holmium laser lithotripsy is a safe and effective method in treating ureteral calculi, it can significantly reduce the displacement of stone and improve the success rate of lithotripsy. The extent of ureteral dilatation is the most important factor affecting the success rate.
Objective To evaluate the clinical effect of the treatment of upper ureteric calculi by ureteral occlusion device combined with holmium laser lithotripsy. Methods From April 2016 to March 2017 patients diagnosed as upper ureteral calculi and underwent ureteroscopic lithotripsy in our hospital were retrospectively analyzed. The catheter group used ureteral occlusion catheter combined with holmium laser lithotripsy, the control group only used holmium laser lithotripsy. The operation effect of the two groups were compared, and Logistic analysis was used to confirm the factor of residual stone rate. Result There was no significant difference between the two groups before surgery, all patients had completed the lithotripsy. In the catheter group(70 patients), 58 cases were successfully treated with one-stage lithotripsy, no stone residue, and 12 patients had residual calculi, 2 patients required extracorporeal shock wave lithotripsy. In the control group(51 patients), 30 patients were successfully treated with one-stage lithotripsy, no stone residued, and 20 patients had residual calculi, 13 patients required extracorporeal shock wave lithotripsy. No serious complications occurred during and after the surgery in both groups.The size of calculi, the extent of hydronephrosis and the extent of ureteral dilatation can affect the success rate of lithotripsy. ConclusionUreteral occlusion catheter combined with holmium laser lithotripsy is a safe and effective method in treating ureteral calculi, it can significantly reduce the displacement of stone and improve the success rate of lithotripsy. The extent of ureteral dilatation is the most important factor affecting the success rate.
引文
[1]那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社,2014,184.
[2]郝继东,廖国强,邓晓俊,等.输尿管封堵导管在输尿管中上段结石钬激光碎石中的应用[J].海南医学,2016,27(15):2537-2539.
[3]金鑫,周鹏,赵文超,等.输尿管镜联合封堵取石导管与输尿管软镜治疗输尿管上段结石的疗效比较[J].临床外科杂志,2017,25(3):188-189.
[4]徐晓龙,史向民,苏雁峰,等.输尿管镜钬激光联合封堵导管、负压吸引管治疗输尿管上段结石[J/CD].中华腔镜泌尿外科杂志(电子版),2015,9(6):423-426.
[5]梁涛,李作为,李永辉,等.封堵取石导管在经尿道输尿管镜激光碎石术中的临床应用分析[J].中国医师进修杂志,2016,39(8):715-717.
[6]李清,曹有汉,陈平锋,等.输尿管封堵取石导管结合钬激光在输尿管中上段结石治疗中的应用[J].中南医学科学杂志,2013,41(5):497-499.
[7]周志华,谭军,梁文.封堵取石导管在输尿管中上段结石治疗中的应用[J].实用医学杂志,2015,31(10):1670-1671.
[8]杨渊,齐琳,祖雄兵.管路封堵导管在输尿管镜碎石术中的应用[J].医药与保健,2014,22(6):37-45.
[9]胡申,杜龙妹.封堵取石导管在输尿管镜钬激光碎石治疗输尿管中下段结石的疗效[J].现代仪器与医疗,2014,20(5):103-104.
[10]周酉枫,汤春波,齐勇,等.封堵取石导管在输尿管镜钬激光碎石术中的应用[J].中国医师进修杂志,2014,37(26):57-58.
[11]吴振声,高向林,陈应驹,等.封堵取石导管与N-trap拦截网在输尿管镜弹道碎石治疗输尿管上段结石的应用比较[J/CD].中华腔镜泌尿外科杂志(电子版),2014,8(4):255-258.
[12]覃智标,雷华,黄瑞旭.输尿管封堵取石导管在输尿管镜气压弹道碎石术中的临床应用[J/CD].中华腔镜泌尿外科杂志(电子版),2013,7(5):14-17.
[13]陶维雄,李辉明,魏世平.封堵取石导管在输尿管镜上段碎石术中的应用[J].国际泌尿系统杂志,2015,35(4):481-482.
[14]刘祥鹏,武立新,王贺彬,等.封堵取石导管在输尿管镜治疗中上段输尿管结石中的应用[J].临床医学研究与实践,2016,1(2):15-16.
[15]吉剑波,瞿兆奎,王峰,等.封堵器在输尿管镜下钬激光碎石术中的疗效分析[J].医学信息,2014,27(11):335-3316.
[16]李鹏,蒋晓明.输尿管镜下钬激光碎石术配合封堵取石导管治疗上段结石的临床分析[J].国际泌尿系统杂志,2014,34(3):325-327.
[2]郝继东,廖国强,邓晓俊,等.输尿管封堵导管在输尿管中上段结石钬激光碎石中的应用[J].海南医学,2016,27(15):2537-2539.
[3]金鑫,周鹏,赵文超,等.输尿管镜联合封堵取石导管与输尿管软镜治疗输尿管上段结石的疗效比较[J].临床外科杂志,2017,25(3):188-189.
[4]徐晓龙,史向民,苏雁峰,等.输尿管镜钬激光联合封堵导管、负压吸引管治疗输尿管上段结石[J/CD].中华腔镜泌尿外科杂志(电子版),2015,9(6):423-426.
[5]梁涛,李作为,李永辉,等.封堵取石导管在经尿道输尿管镜激光碎石术中的临床应用分析[J].中国医师进修杂志,2016,39(8):715-717.
[6]李清,曹有汉,陈平锋,等.输尿管封堵取石导管结合钬激光在输尿管中上段结石治疗中的应用[J].中南医学科学杂志,2013,41(5):497-499.
[7]周志华,谭军,梁文.封堵取石导管在输尿管中上段结石治疗中的应用[J].实用医学杂志,2015,31(10):1670-1671.
[8]杨渊,齐琳,祖雄兵.管路封堵导管在输尿管镜碎石术中的应用[J].医药与保健,2014,22(6):37-45.
[9]胡申,杜龙妹.封堵取石导管在输尿管镜钬激光碎石治疗输尿管中下段结石的疗效[J].现代仪器与医疗,2014,20(5):103-104.
[10]周酉枫,汤春波,齐勇,等.封堵取石导管在输尿管镜钬激光碎石术中的应用[J].中国医师进修杂志,2014,37(26):57-58.
[11]吴振声,高向林,陈应驹,等.封堵取石导管与N-trap拦截网在输尿管镜弹道碎石治疗输尿管上段结石的应用比较[J/CD].中华腔镜泌尿外科杂志(电子版),2014,8(4):255-258.
[12]覃智标,雷华,黄瑞旭.输尿管封堵取石导管在输尿管镜气压弹道碎石术中的临床应用[J/CD].中华腔镜泌尿外科杂志(电子版),2013,7(5):14-17.
[13]陶维雄,李辉明,魏世平.封堵取石导管在输尿管镜上段碎石术中的应用[J].国际泌尿系统杂志,2015,35(4):481-482.
[14]刘祥鹏,武立新,王贺彬,等.封堵取石导管在输尿管镜治疗中上段输尿管结石中的应用[J].临床医学研究与实践,2016,1(2):15-16.
[15]吉剑波,瞿兆奎,王峰,等.封堵器在输尿管镜下钬激光碎石术中的疗效分析[J].医学信息,2014,27(11):335-3316.
[16]李鹏,蒋晓明.输尿管镜下钬激光碎石术配合封堵取石导管治疗上段结石的临床分析[J].国际泌尿系统杂志,2014,34(3):325-327.