[1]顾志文,郑彬**,罗发彩,等.输尿管硬镜与软镜治疗10~20 mm输尿管上段结石的比较[J].中国微创外科杂志,2018,18(9):814-818.
　Gu Zhiwen,Zheng Bin,Luo Facai,et al.Comparison of Rigid and Flexible Ureteroscopy for the Treatment of Upper Ureteral Stones Sized 10-20 mm[J].Chinese Journal of Minimally Invasive Surgery,2018,18(9):814-818.
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输尿管硬镜与软镜治疗10~20 mm输尿管上段结石的比较()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
18
期数:
2018年9期
页码:
814-818
栏目:
临床研究
出版日期:
2018-12-06

文章信息/Info

Title:
Comparison of Rigid and Flexible Ureteroscopy for the Treatment of Upper Ureteral Stones Sized 10-20 mm
作者:
顾志文; 郑彬**; 罗发彩; 张贺庆; 宋生生; 陈岳; 詹河涓
广东省佛山市禅城区中心医院泌尿外科，佛山528031
Author(s):
Gu Zhiwen;  Zheng Bin;  Luo Facai;  et al.
Department of Urology, Foshan Chancheng Central Hospital, Foshan 528031, China
关键词:
输尿管结石; 输尿管硬镜; 输尿管软镜
Keywords:
Ureteral stone; Rigid ureteroscopy; Flexible ureteroscopy
文献标志码:
A
摘要:
目的比较输尿管硬镜(rigid ureteroscopy，R-URS)和输尿管软镜(flexible ureteroscopy，F-URS)治疗输尿管上段结石的疗效和安全性。方法回顾性比较我院2014年12月~2016年12月输尿管上段结石(直径10~20 mm)53例，其中R-URS治疗25例（R-URS组），F-URS 治疗28例（R-URS组），比较2组手术时间、一次碎石成功率、结石清除率、手术并发症、术后住院时间和住院费用等。结果53例均能顺利入镜，F-URS组一次碎石成功率96.4%(27/28)，显著高于R-URS组72.0%（18/25）（χ2=4.391，P=0.036）；术后2周结石清除率92.9%(26/28)，显著高于R-URS组64.0%(16/25) (χ2=6687，P=0.010)；残余结石行体外冲击波碎石(extracorporeal shock wave lithotripsy, ESWL)后4周结石清除率分别为88.0%(22/25)、96.4%(27/28)，无显著性差异（χ2=0.408，P=0.523）；随访半年结石清除率分别为92.0%(23/25)、96.4%(27/28)，无显著性差异（χ2=0.010，P=0.919）。2组均无严重手术并发症，R-URS组输尿管黏膜挫伤发生率36.0%(9/25)，显著高于F-URS组7.1%（2/28） (χ2=6.687，P=0.010)；R-URS组血红蛋白丢失量中位数9.0 g/L（-1.0~23.0 g/L），明显高于F-URS组0.5 g/L（-14.0~15.0 g/L） (Z=-3.685，P=0.000)，但均无一例输血治疗。F-URS组住院费用（25 579.2±4324.3）元，显著高于R-URS组(14 309.9±2932.6)元（t=-10.967，P=0.000）。结论对于10~20 mm输尿管上段结石的治疗，F-URS和R-URS均安全可行，F-URS结石清除率高，并发症少，可作为首选治疗方式，但费用较高；R-URS费用相对较低，术后往往需要结合ESWL治疗才能有较好的疗效。
Abstract:
ObjectiveTo compare the effect and feasibility between rigid ureteroscopy (R-URS) and flexible ureteroscopy (F-URS) in the management of upper ureteral stones.MethodsA total of 53 patients withupper ureteral stones (sized 10-20 mm) in our hospital from December 2014 to December 2016 were retrospectively investigated. Of them, 25 cases received R-URS and 28 underwent F-URS, respectively. The two groups were compared and analyzed statistically in terms of operation time, success rate of stone fragmentation, stone-free rate, surgical-related complications, postoperative hospital stay and total hospital cost.ResultsSuccessful access was achieved in all the patients. The success rate of stone fragmentation was 96.4%(27/28) in the F-URS group and 72.0%(18/25) in the R-URS group, with significant difference (χ2=4391, P=0.036). In the F-URS group, the initial stone-free rate in 2 weeks achieved 92.9%(26/28), which was significantly higher than 64.0%(16/25) in the R-URS group (χ2=6.687, P=0.010). However, with the aid of ESWL for residual stone fragments, there was no statistically significant difference in terms of overall stone free rate in 4 weeks ［88.0%(22/25) vs. 96.4%(27/28), χ2=0.408, P=0.523］ and 6 months ［92.0%(23/25) vs. 96.4%(27/28), χ2=0.010, P=0.919］ between the two groups, respectively. No major complications were encountered. Ureteral mucosal injury was observed in 36.0% (9/25) patients in the R-URS group and 7.1%(2/28) patients in the F-URS group, respectively, with significant difference (χ2=6.687, P=0.010). As compared to the F-URS group, the R-URS group was associated with much more loss of hemoglobin ［median:9.0 g/L (range,-1.0-23.0 g/L) vs. 05 g/L (range,-14.0-15.0 g/L), Z=-3.685, P=0.000). Nevertheless, no patients required blood transfusion. In addition, significant difference was found between the R-URS and F-URS group in regard to hospitalization cost ［(14 309.9±2932.6) yuan vs. (25 579.2±4324.3) yuan, t=-10.967, P=0.000］.ConclusionsBoth R-URS and F-URS are safe and feasible for patients with upper ureteral stones in size of 10-20 mm. Regardless of high cost, F-URS can be the first choice with higher stone free rate and less complications. R-URS achieves low stone free rate for upper ureteral stones unless it is combined with ESWL.

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备注/Memo

备注/Memo:
基金项目：2017年广东省医学科学技术研究基金项目（B2017043）；2017年佛山市医学类科技攻关项目（2017AB002381）**通讯作者，E-mail：2627929713@qq.com
更新日期/Last Update: 2018-12-06