摘要
目的探讨钬激光与气压弹道碎石治疗合并输尿管梗阻病变结石在手术安全性、疗效方面的差异性。方法采用随机分组法进行研究,在532例568侧输尿管结石患者中,将100例合并有输尿管梗阻性病变患者分为钬激光治疗组和气压弹道碎石组,各50例;钬激光组使用钬激光处理输尿管合并病变(狭窄、肉芽、息肉、囊肿等)然后碎石;气压弹道组采用镜身扩张、气囊扩张、鳄嘴钳夹除处理病变,然后碎石治疗。结果钬激光组50例患者单次腔内手术成功率82%(41/50),中转开放手术1例,8例因不能到达结石部位碎石而置双J管行ESWL治疗;结石粉碎率95.1%(39/41),2例结石漂移至肾盂改ESWL治疗;结石排净率术后7d内56.4%(22/39)术后30d内82.1%(32/39),术后90d内92.3%(36/39);气压弹道碎石组50例患者单次腔内手术成功率64%(32/50),12例不能到达结石部位无法行气压弹道碎石,留置双J管行ESWL治疗,6例患者术中输尿管损伤转开放手术,原位结石粉碎率78.1%(25/32),其中7例患者因大块结石漂移至肾盂而致碎石失败;结石排净率术后7d内32%(8/25),术后30d内56%(14/25),术后90d内72%(18/25)。钬激光组在单次腔内手术成功率,原位结石粉碎率、结石排净率方面与气压弹道碎石组相比有较大优势,差异有显著性(P<0.05)。结论对于合并输尿管梗阻性病变结石患者,钬激光具有安全性高、单次手术成功率高、原位结石粉碎率、排净率高,并发症少的优点,是该类复杂输尿管结石治疗首选方法之一。
[ Objective ] To compare the effect and safety of ureteroscopic holmium laser lithotripsy and pneumatic lithotripsy for uretal calculi which were combined uretal obstructive diseases. [ Methods ] In a total of 532 uretal stone patients （568 sides）, 100 patients who also had uretal obstructive diseases were randomly divided into 2 groups with 50 in each. Lesions including granulation tissue, uretal polypi,stricture and cyst in the patients of holmium laser group were treated with holmium laser. Patients in pneumatic lithotripsy group were treated with pneumatic lithotripsy, uretal obstructive diseases were treated with uretal dilatation. [ Results] For patients in holmium laser group, the cure rate of a single procedure was 82%, of which 1 was converted to open operation,8 case were converted to ESWL after placing D-J tube. The overall stone segmentation rate was 95.1% （39/41）. The stone-free rate was 56.4% （22/39） in 7 days, 82.1% （32/39） in 30 days, 92.3% （36/39） in 90 days. For patients in pneumatic lithotripsy group, the cure rate of a single procedure was 64% （32/50）, 12 cases were converted to ESWL after placing D-J tube, 6 patients were converted to open operation because of uretal injury. The overall stone segmentation rate was 78.1% （25/32）; 7 cases experienced failure because large fragment stones （diameter〉5 mm） returned to the kidney. The stone-free rate was 32% （8/25） in 7 days, 56% （14/25） in 30 days, 72% （18/25） in 90 days. The differences in single-procedure successful rate, the overall stone segmentation rate, the stone-free rate were significantly higher in holmium laser group than in pneumatic lithotripsy group （P 〈0.05）. [ Conclusion] Ureteroseopie holmium laser lithotripsy is an effective and safe treatment modality for uretal calculi which are combined ureteral obstructive diseases. It is one of the best choices for treating this kind of complicated uretal calculi.
出处
《中国内镜杂志》
CSCD
北大核心
2009年第10期1032-1035,1038,共5页
China Journal of Endoscopy
关键词
钬激光
气压弹道碎石
输尿管结石
holmium laser
pneumatic lithotripsy
uretal calculi
