标题：输尿管镜钬激光碎石联合输尿管导引鞘治疗输尿管上段结石疗效观察

      作者：冯权尧，徐勋，杨云杰，黄益恒    (南方医科大学附属南海医院泌尿外科，广东 佛山 528200)

      卷次： 2018年29卷23期

      【摘要】 目的 探讨输尿管镜钬激光碎石联合输尿管导引鞘治疗输尿管上段结石的安全性及有效性。方法 选取南方医科大学附属南海医院泌尿外科2016年3月至2018年2月收治的输尿管上段结石患者126例，采用随机数表法将患者分为观察组和对照组，每组63例。观察组患者在输尿管镜钬激光碎石术的基础上联合输尿管导引鞘治疗，对照组则单纯使用输尿管镜钬激光碎石术治疗。比较两组患者的手术时间、住院时间、术中结石上移率、碎石成功率，术后1个月结石清除率及手术并发症的发生情况，并采用视觉模拟评分法(VAS)量表评价两组患者手术前后的疼痛缓解情况。结果 观察组患者的手术时间和术后发热发生率分别为(32.4±8.7) min和4.76%，明显低于对照组的(41.8±9.3) min和19.05%，差异均有统计学意义(P<0.05)；观察组患者的结石上移率为6.35%，明显低于对照组的20.63%，结石清除率为92.06%，明显高于对照组的77.78%，差异均有统计学意义(P<0.05)；观察组和对照组患者的碎石成功率分别为93.65%、80.95%，差异无统计学意义(P>0.05)；观察组患者治疗后1 d和3 d的VAS评分分别为(3.3±0.9)分和(1.6±0.9)分，均较治疗前的(5.3±1.0)分显著降低，差异均具有显著统计学意义(P<0.01)；对照组患者治疗后1 d和3 d的VAS评分分别为(3.6±0.8)分和(2.0±1.0)分，均较治疗前的(5.2±1.0)分显著降低，差异均具有显著统计学意义(P<0.01)；观察组患者治疗后1 d和3 d的VAS评分均明显低于对照组，差异均有统计学意义(P<0.05)。结论 输尿管镜钬激光碎石联合输尿管导引鞘治疗输尿管上段结石能缩短手术时间，减少结石上移率，提高结石清除率，减少并发症，降低术后疼痛，是一种安全有效的治疗方法。
      【关键词】 钬激光碎石；输尿管导引鞘；输尿管上段结石；疗效；安全性
      【中图分类号】 R691.4 【文献标识码】 A 【文章编号】 1003—6350（2018）23—3308—04

Effect of ureteroscopic holmium laser lithotripsy combined with ureter-guided sheath in the treatment of upperureteral calculi.
FENG Quan-yao, XU Xun, YANG Yun-jie, HUANG Yi-heng. Department of Urology, Nanhai HospitalAffiliated to Southern Medical University, Foshan 528200, Guangdong, CHINA
【Abstract】 Objective To investigate the safety and efficacy of ureteroscopic holmium laser lithotripsy com-bined with ureteral sheathing in the treatment of upper ureteral calculi. Methods A total of 126 upper ureteral calculipatients treated in the Department of Urology in the Nanhai Hospital Affiliated to Southern Medical University fromMarch 2016 to February 2018 were selected and randomly divided into the observation group and the control group,with 63 cases in each group. The observation group was treated with ureteroscopic holmium: YAG laser lithotripsy com-bined with ureteral sheath, while the control group was treated with ureteroscopic holmium laser lithotripsy. The opera-tion time, hospitalization time, the rate of stone removal, the success rate of lithotripsy, the stone clearance rate, and theincidence of postoperative complications were compared between the two groups. The pain relief of the two groups be-fore and after operation was evaluated by Visual Analogue Scale (VAS). Results The time of operation and the inci-dence of postoperative fever in the observation group were (32.4±8.7) min and 4.76%, respectively, which were signifi-cantly lower than (41.8±9.3) min and 19.05% in the control group (P<0.05). The upward removal rate of stones in the ob-servation group was 6.35%, which was significantly lower than 20.63% in the control group, and the stone clearance ratewas 92.06%, which was significantly higher than 77.78% in the control group (P<0.05). The success rate of lithotripsywas 93.65% in the observation group versus 80.95% in the control group (P>0.05). The VAS score in the observationgroup were (3.3±0.9) and (1.6±0.9) respectively on the 1st and 3rd day after treatment, which were significantly lower thanthose before treatment (5.3±1.0), P<0.01. The VAS score in the control group were (3.6±0.8) and (2.0±1.0) on the 1st and3rd day after treatment respectively, which were significantly lower than those before treatment (5.2±1.0), P<0.01. TheVAS scores in the observation group were significantly lower than those in the control group on the 1st and 3rd day aftertreatment (P<0.05). Conclusion Ureteroscopic holmium (YAG laser lithotripsy combined with ureteral sheathing) is asafe and effective method for the treatment of upper ureteral calculi.
      【Key words】 Holmium laser lithotripsy; Ureteral sheathing; Upper ureteral calculi; Curative effect; Safety·论 著·doi:10.3969/j.issn.1003-6350.2018.23.017