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目的:对比单独使用钬激光与配合钬激光使用NTrap网篮在输尿管镜碎石术治疗上段输尿管结石中的临床疗效。方法:诊断患有输尿管上段结石的患者共106例115侧,住院期间均采用输尿管镜下钬激光碎石术进行治疗。其中对照组70侧,观察组45侧,对照组在术中单独使用钬激光碎石,观察组在术中同时配合钬激光使用NTrap网篮。比较对照组和观察组术中结石上移率、手术成功率,术后1个月结石排净率及术中术后并发症的发生情况。结果:术中对照组和观察组结石上移率分别为24.29%(17/70)和6.67%(3/45),碎石成功率分别为80.00%(56/70)和95.56%(43/45),手术成功的两组术后1个月结石排净率分别为82.14%(46/56)和95.35%(41/43),两组术中结石上移率、手术成功率和术后结石排净率相比较差异有统计学意义(P<0.05)。对照组术中发生输尿管穿孔2侧,观察组发生输尿管穿孔1侧。术后对照组有2例患者出现严重血尿,观察组1例出现严重血尿。对照组与观察组术后各有4例患者出现发热。两组术中术后相关并发症的发生率相比较差异无统计学意义(P>0.05)。结论:在输尿管镜碎石术治疗输尿管上段结石时,使用NTrap网篮配合钬激光碎石可以显著降低结石的上移率,提高手术成功率和术后1个月结石排净率,是一种安全、有效的方法。
OBJECTIVE: To compare the clinical efficacy of ureteroscopic lithotripsy in the treatment of upper ureteral calculi with holmium laser and holmium laser with NTrap mesh. Methods: One hundred and sixty-six cases of 115 patients diagnosed as having upper ureteral calculi were treated with ureteroscopic holmium laser lithotripsy during hospitalization. The control group, 70 sides, observation group, 45 sides, the control group in the surgery alone with holmium laser lithotripsy, the observation group in the surgery with holmium laser using NTrap basket. The control group and observation group intraoperative stone movement rate, the success rate of surgery, 1 month after the stone removal rate and intraoperative and postoperative complications occurred. Results: The uplift rates of stones in control group and observation group were 24.29% (17/70) and 6.67% (3/45) respectively, and the successful rates of grading were 80.00% (56/70) and 95.56% (43 / 45). The stone clearance rates at one month after operation were 82.14% (46/56) and 95.35% (41/43), respectively. There was no significant difference between the two groups in the rate of upward movement of stones, the success rate of operation, The rate of stone discharge was significantly different (P <0.05). In the control group, 2 cases of ureter perforation occurred in the operation group and 1 case of ureter perforation in the observation group. Serious hematuria occurred in 2 patients in the control group and severe hematuria in 1 patient in the observation group. In the control and observation groups, 4 patients developed fever after operation. There was no significant difference in the incidence of postoperative complications between the two groups (P> 0.05). Conclusion: Ureteroscopic lithotripsy in the treatment of upper ureteral calculi, the use of NTrap basket with holmium laser lithotripsy can significantly reduce the rate of stone uplift, improve the success rate of surgery and stone clearance rate after 1 month, is a Safe and effective method.