摘要
目的探讨输尿管上段结石的适宜处理方法,比较输尿管镜钬激光碎石联合封堵取石导管与N-Trap拦截网治疗输尿管上段结石的临床效果。方法采用整群抽样的方法并根据手术中使用辅助器械的不同分析2009年1月-2015年1月在川北医学院附属医院接受治疗的单侧输尿管结石患者223例,其中单独使用输尿管硬镜碎石54例(A组),输尿管镜联合使用封堵取石导管79例(B组),输尿管镜联合使用N-Trap拦截网90例(C组)。比较3组间一次性碎石成功率、清石率、手术时间及手术并发症发生率。结果一次性碎石成功率比较:A组37/54(68.5%),B组65/79(82.2%),C组85/90(94.4%),3组间比较差异有统计学意义(P<0.01)。清石率比较,A组为27/37(72.9%),B组为56/65(86.1%),C组为80/85(94.1%);B、C组与A组比较有统计学意义(P=0.046),表明输尿管镜联合使用结石封堵装置可提高结石清除率。手术时间:A组为(34.5±12.2)min,B组为(47.3±15.4)min,C组为(45.6±14.5)min。A组分别与B、C组比较手术时间更短,差异有统计学意义(P<0.01);B、C组比较差异无统计学意义(P=0.445)。手术并发症之间差异无统计学意义。结论对于输尿管上段结石选择单纯使用输尿管镜碎石的方法并非最佳选择。封堵取石导管与N-Trap拦截网具有不同的设计特点,但就该院临床使用的效果分析,N-Trap拦截网对结石的阻拦、提高手术成功率及清石率方面优于封堵取石导管。
Objective To explore the treatment of proximal ureteral calculi, and to evaluate the clinical efficacy and safety of two different ureteral occlusion devices INNOVEX TMIVX-SC10 and N-Trap（Cook urological） in the ureteroscopic holmium laser lithotripsy. Methods A total of 223 patients with proximal ureteric stones were prospectively divided into three groups in this study. In the group A（54 patients）, the patients underwent holmium laser lithotripsy without any ureteral occlusive device. In the group B（79 cases）, the INNOVEX TMIVX-SC10 ureteral occlusive device was used. And in the group C（90 cases）, the N-Trap was used. One-time successful rate of lithotripsy, stone-free rate, operation time and occurrence of surgical complications were compared among the three groups. Results A total of 187 patients had lithotripsy completed successfully; among which 37 patients（68.5%） were in the group A, 65 patients（82.2%） in the group B and 85 patients（94.4%） in the group C. It was significantly different from each other（P〈0.05）. The stone-free rate was 72.9%, 86.1% and 94.1% in the group A, B and C,respectively. The stone-free rate of the group A was significantly lower than those of the groups B and C（P〈0.05）.There were no significant differences in severe complications among the groups. Conclusions The ureteroscopy without assistance of any ureteral occlusive device is not an optimal method for proximal ureteral calculi. Both ureteral occlusion devices INNOVEX TMIVX-SC10 and N-Trap（Cook urological） are valuable during ureteroscopic holmium laser lithotripsy; however, the N-trap is more effective in preventing proximal stone migration and raising subsequent stone-free rate.
出处
《中国现代医学杂志》
CAS
北大核心
2016年第6期119-122,共4页
China Journal of Modern Medicine
基金
四川省教育厅2013年自然科学重点项目(No:13ZA0218)
