逆行输尿管镜碎石术治疗嵌顿性输尿管结石的临床研究

发布时间：2018-11-25 11:54

【摘要】：目的：探讨逆行输尿管镜钬激光碎石术对嵌顿性输尿管结石的治疗效果,并对手术效果的相关因素进行分析。方法：选择我院128例输尿管结石患者,根据结石是否嵌顿,分为非嵌顿组70例和嵌顿组58例,比较逆行输尿管镜钬激光碎石术对两组患者的疗效、手术并发症情况,并分析两组手术失败的原因和嵌顿组碎石成功率与结石位置和大小的关系。结果：非嵌顿组与嵌顿组的一次性碎石成功率、手术时间、术后肉眼血尿发生率分别为91.4%(64/70)与74.1%(43/58)、(36.3±10.7)min与(45.2±13.9)mmin、51.4%(36/70)与84.5%(49/58),差异有统计学意义(P0.05)。非嵌顿组与嵌顿组术后住院时间、止痛药使用率、尿路感染率、输尿管穿孔率分别是(1.5±1.2)d与(1.9±1.4)d、1.4%(1/70)与6.9%(4/58)、7.1%(5/70)与12.1%(7/58)、0(0/70)与6.9%(4/58),差异无统计学意义(P0.05)。非嵌顿组中共6例手术失败,主要原因是术中输尿管结石上移；嵌顿组15例手术失败,主要原因包括结石残片上移、输尿管过度扭曲、输尿管狭窄、输尿管穿孔、结石大而硬。在嵌顿组中有32例合并有输尿管壁肉眼的病理变化,其中输尿管黏膜明显充血水肿22例,输尿管壁肉芽或息肉6例,输尿管狭窄4例。嵌顿组中位于腰4椎体横突以上的结石碎石成功率为58.3%,而腰4椎体横突以下为85.3%,差异有统计学意义P0.05)。嵌顿组中在腰4椎体横突上、下结石直径1cm与≤1cm组的碎石成功率分别为63.6%(7/11)、53.8%(7/13)和78.9%(15/19)、93.3%(14/15),差异均无统计学意义(P0.05)；嵌顿组中腰4椎体横突上、下轻中度与重度组肾积水手术成功率分别为57.1%(8/14)、60%(6/10)和81.3%(13/16)、88.9%(16/18),差异均无统计学意义P0.05)。结论：嵌顿性输尿管结石较非嵌顿性结石手术难度大,碎石成功率低,主要影响因素为输尿管扭曲及结石碎片上移；嵌顿性输尿管结石可合并输尿管壁充血水肿、炎性肉芽和息肉、输尿管狭窄；在腰4椎体横突平面以上,嵌顿性结石的碎石成功率较该平面以下的低,嵌顿性输尿管结石的碎石成功率可能与结石大小和肾积水程度无明显关系。
[Abstract]:Objective: to investigate the effect of retrograde ureteroscopic holmium: YAG laser lithotripsy on incarcerated ureteral calculi. Methods: 128 patients with ureteral calculi in our hospital were divided into non-incarcerated group (n = 70) and incarcerated group (n = 58) according to whether they were incarcerated. The efficacy and complications of retrograde ureteroscopic holmium laser lithotripsy were compared. The causes of failure and the relationship between the success rate of stone and the location and size of stone in incarcerated group were analyzed. Results: the success rate and operative time of unincarcerated group and incarcerated group were 91.4% (64 / 70) and 74.1% (43 / 58), (36.3 卤10.7) min and (45.2 卤13.9) mmin, respectively. 51.4% (36 / 70) and 84.5% (49 / 58), the difference was statistically significant (P0.05). The postoperative hospitalization time, analgesic usage rate, urinary tract infection rate and ureteral perforation rate were 1.4% (1 / 70) and 6.9% (4 / 58) in non-incarcerated and incarcerated groups, respectively. There was no significant difference between 7.1% (5 / 70) and 12. 1% (7 / 58), 0 (0 / 70) and 6.9% (4 / 58) (P0.05). In the non-incarcerated group, 6 cases failed, the main reason was the upward movement of ureteral calculi during the operation, 15 cases in the incarcerated group failed, the main reasons included the upward movement of stone fragments, the excessive distortion of ureter, the stricture of ureter, ureteral perforation, large and hard stone. In the incarcerated group, 32 cases were accompanied with pathological changes of ureteral wall, including 22 cases of hyperemia and edema of ureteral mucosa, 6 cases of granulation or polyp of ureteral wall and 4 cases of ureteral stricture. In the incarcerated group, the success rate of lithotripsy above the transverse process of the lumbar 4 vertebrae was 58.3, while that below the transverse process of the lumbar 4 vertebrae was 85.3, the difference was statistically significant (P0.05). In the incarcerated group, the lithotripsy success rates of 1cm and 鈮，

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