三种输尿管镜治疗输尿管上段结石的疗效比较

目的:比较半硬性输尿管镜、输尿管软镜、孙氏末段可弯输尿管镜治疗输尿管上段结石的临床疗效,为临床上治疗方式的选择提供参考。方法:回顾性分析2015年8月到2017年12月间于上海市第十人民医院泌尿外科因输尿管上段结石行输尿管镜下钬激光治疗的515例患者的临床资料。按照所用输尿管镜类型分为3组:硬镜组(给予半硬性输尿管镜治疗)297例,软镜组172例(给予输尿管软镜治疗),孙氏镜组(给予孙氏末段可弯输尿管镜治疗)46例。比较三组的手术时间、一期清石率、术后住院时间及术中、术后并发症。结果:硬镜组、软镜组、孙氏镜组清石率分别为81.5%、94.2%、95.7%,其中软镜组、孙氏镜组清石率显著高于硬镜组(P0.05)。硬镜组、软镜组、孙氏镜组术中并发症发生率分别为18.9%、5.8%、4.3%,其中硬镜组术中并发症发生率显著高于软镜组和孙氏镜组(P0.05),三组术后并发症发生率整体比较差异无统计学意义(P0.05)。硬镜组、软镜组、孙氏镜组平均手术时间分别为(28.6±6.2)min、(49.4±12.4)min、(26.1±6.5)min,软镜组平均手术时间显著高于硬镜组及孙氏镜组,差异有统计学意义(均P0.05)。硬镜组、软镜组、孙氏镜组平均住院时间分别为(5.4±3.2)d、(6.7±5.7)d、(5.0±2.5)d,软镜组住院时间显著高于硬镜组和孙氏镜组,差异有统计学意义(均P0.05)。结论:软镜清石效果和手术安全性较硬镜更有优势,但手术耗时长,患者术后住院时间长。孙氏镜有望成为治疗输尿管上段结石的更佳选择。

Comparison of Curative Effect of Three Ureteroscopy in the Treatment of Upper Ureteral Calculi

ABSTRACT Objective: To compare the clinical effect of semi rigid ureteroscopy, flexible ureteroscopy and Sun''s endoscopy with ureteroscopy in the treatment of upper ureteral calculi, and provide reference for the choice of clinical treatment. Methods: The clinical data of 515 cases in the Department of Urology of our hospital from August 2015 to December 2017 with ureteroscopic holmium laser treatment of upper ureteral calculi were retrospective analyzed. They were divided into three groups according to the type of ureteroscopy, there were 297 cases in hard mirror group (treated with semi rigid ureteroscopy), 172 cases in soft mirror group (treated with flexible ureteroscopy), and 46 cases in Sun''s mirror group (treated with Sun''s endoscopy with ureteroscopy). The operation time,first stage stone clearance rate, postoperative hospitalization time, intraoperative and postoperative complications were compared between the three groups. Results: The stone clearing rate in hard mirror group, soft mirror group and Sun''s mirror group were 81.5%, 94.2% and 95.7% respectively, and stone clearing rate in the soft mirror group and Sun''s mirror group were significantly higher than that in the hard mirror group (P<0.05). The incidence of intraoperative complications in the hard mirror group, soft mirror group and Sun''s mirror group were 18.9%, 5.8% and 4.3% respectively. The incidence of intraoperative complications in the hard mirror group were significantly high- er than that in the soft mirror group and Sun''s mirror group (P<0.05). There was no significant difference in the incidence of postoperative complications between the three groups (P>0.05). The average operation time in the hard mirror group,soft mirror group and Sun''s mirror group were (28.6±6.2)min, (49.4±12.4)min, (6.1±6.5)min respectively. The average operation time in the soft mirror group were sig- nificantly higher than that in the hard mirror group and Sun''s mirror group, the differences were statistically significant (all P<0.05). The average hospitalization time in the hard mirror group, soft mirror group and Sun''s mirror group were (5.4±3.2)d, (6.7±5.7)d, (5.0±2.5)d respectively. The time of hospitalization in the soft mirror group were significantly higher than that in the hard mirror group and Sun''s mirror group, the differences were statistically significant (all P<0.05). Conclusion: The effect of clearing stone and the safety of opera- tion of flexible ureteroscopy is more advantageous than rigid ureteroscopy, but the operation time and the postoperative hospitalization time is long. Sun''s endoscopy with ureteroscopy is expected to be a better choice for the treatment of upper ureteral calculi.