目的 对照分析输尿管软镜与微通道经皮肾镜碎石术治疗输尿管上段结石的疗效及安全性。方法选取2015年6月—2017年6月间输尿管上段结石患者180例,其中90例采用输尿管软镜钬激光碎石术治疗(输尿管软镜组),90例采用微通道经皮肾镜钬激光碎石术治疗(微通道经皮肾镜组),观察比较两组患者的手术时间、术中出血量、清石率、术后住院天数、BCS舒适度评分、疼痛VAS评分以及C反应蛋白(CRP)和白细胞计数(WBC)等指标的差异,以及两组术后并发症的情况。结果 两组患者均无穿刺及置镜失败者,术后3～6 d摄泌尿系统平片,双J管位置均正常;两组患者的手术时间、清石率、WBC数值差异均无统计学意义(P>0.05);输尿管软镜组术中出血量、术后住院天数、疼痛VAS评分、CRP均少于微通道经皮肾镜组,舒适度评分高于微通道经皮肾镜组,差异均有统计学意义(P<0.01)。输尿管软镜组术后发热2例,加强抗感染后好转,无中转手术;微通道经皮肾镜组无需要介入的出血及严重感染并发症。结论 与微通道经皮肾镜碎石术相比,输尿管软镜碎石术治疗输尿管上段结石患者舒适度高,更为安全,且疗效确切,在临床治疗输尿管上段结石时值得优先考虑。
Objective To compare the effects and security of flexible ureteroscope lithotripsy and mini-percutaneous nephrolithotomy on upper ureteric calculi.Methods A total of 180 cases of upper ureteric calculi were selected from June 2015 to June 2017.Among them,90 cases were given flexible ureteroscopy lithotripsy with holmium laser as flexible ureteroscope group,and the rest 90 cases were given mini-percutaneous nephrolithotomy with holmium laser as mini-percutaneous nephrolithotomy group.The two groups were compared in operation time,blood loss volume during operation,stone clearance rate,postoperative hospital stay,BCS comfort score,VAS pain score,C reaction protein (CRP),white blood cell (WBC) count,and complications.Results There was no puncture failure or flexible ureteroscope lithotripsy failure cases in the two groups,and 3-6 d after operation,the positions of double J stents were normal.There was no significant difference in operation time,stone clearance rate,and WBC count between the two groups (P>0.05).In the flexible ureteroscope group,the blood loss volume during operation,postoperative hospital stay,VAS pain score,and CRP were lower,and the BCS comfort score was higher than those in the mini-percutaneous nephrolithotomy group,with significant differences (P<0.01).Two cases had fever in the flexible ureteroscope group and no conversions to open surgery.No serious complication was found in the mini-percutaneous nephrolithotomy group.Conclusion Compared with mini-percutaneous nephrolithotomy,flexible ureteroscope lithotripsy could bring more comfort,safety,and definite therapeutic effect for patients with upper ureteric calculi.
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