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目的:探讨输尿管结石术前的综合评价在确定和指导碎石方式的选择、提高碎石效率方面的作用。方法:将645例患者分为随机组(178例)和综合评价组(467例)。术前进行综合评价,按结石部位分为输尿管上段、中段和下段,按结石大小分为≤7mm、8～10mm、>10mm,按结石密度分为高密度、中密度、疏松结石,按结石数量分为单发、多发。在碎石方法的选择上遵循下段、≤7mm、疏松结石和单发结石优先考虑采用气压弹道碎石;中密度、中段、8～10mm、多发结石优先考虑采用双频激光碎石;上段、>10mm、高密度、多发结石优先考虑采用钬激光碎石的原则。结果:随机组采用气压弹道碎石52例,双频激光碎石85例,钬激光碎石41例。综合评价组采用气压弹道碎石107例,双频激光碎石148例,钬激光碎石212例。两组碎石成功率分别为88.2%和93%,结石排净率分别为84%和89.3%。患者平均住院天数分别为7天和5天。平均住院费用综合评价组比随机组下降5%～8%。结论:术前对患者进行综合评价,并指导选择合理的碎石方式,可以使碎石成功率、结石排净率和住院时间均达到最佳,使住院费用明显降低。
OBJECTIVE: To investigate the effect of preoperative comprehensive evaluation of ureteral calculi in determining and guiding the choice of gravel ways and improving the efficiency of gravel. Methods: 645 patients were divided into randomization group (178 cases) and comprehensive evaluation group (467 cases). Preoperative comprehensive evaluation, according to the stone site is divided into the upper ureter, the middle and lower segments, according to the size of the stone is divided into ≤ 7mm, 8 ~ 10mm,> 10mm, according to the stone density is divided into high density, density, loose stones, Divided into single, multiple. In the choice of gravel method to follow the next paragraph, ≤ 7mm, loose stones and single stone is preferred to use pneumatic lithotripsy; medium density, the middle, 8 ~ 10mm, multiple stones give priority to using dual-frequency laser lithotripsy; 10mm, high density, multiple stones give priority to the principle of holmium laser lithotripsy. Results: In random group, 52 cases were treated by pneumatic lithotripsy, 85 cases were dual-frequency laser lithotripsy, 41 cases were holmium laser lithotripsy. The comprehensive evaluation group used pneumatic lithotripsy in 107 cases, dual-frequency laser lithotripsy in 148 cases, holmium laser lithotripsy in 212 cases. The success rates of the two gravels were 88.2% and 93% respectively, and the stone clearance rates were 84% and 89.3% respectively. The average length of hospital stay was 7 days and 5 days respectively. The average cost of hospitalization comprehensive evaluation group than in the random group decreased by 5% to 8%. Conclusion: The comprehensive evaluation of the patients before operation and the guidance of choosing a reasonable gravel method can make the success rate of gravel, the rate of stone removal and the length of hospital stay reach the best, and the cost of hospitalization is significantly reduced.