探讨使用改良的输尿管硬镜钬激光碎石术治疗输尿管上段结石的临床疗效。

选取2015年5月至2017年5月山西医科大学第一医院泌尿外科进行治疗的115例单侧输尿管上段单发结石（结石具体位置距肾盂输尿管连接部≤5 cm）患者，分别行改良输尿管硬镜碎石治疗（改良组，72例）和传统输尿管硬镜碎石治疗（对照组，43例）。与对照组相比，改良组输尿管硬镜进水阀与出水阀分别经三通连接进水管与负压吸引器，采取改良截石位，在封堵器的引导下置入输尿管硬镜，人工控制进水速度，利用200 μm细光纤碎石，通畅引流后小壶输注呋塞米。两组在年龄、性别、结石侧别、肾积水程度、结石距肾盂输尿管连接部距离和结石大小方面，差异无统计学意义（P>0.05）。比较两组患者的一期清石率及漂移率。

清石率方面，改良组为93.06％（67/72），对照组为62.79％（27/43），两组间差异有统计学意义（χ²=16.52，P<0.05），漂移率方面改良组为5.56％（4/72），对照组为41.86％（18/43），两组间差异有统计学意义（χ²=22.94，P<0.05），术中及术后均无输尿管穿孔、输尿管撕脱等严重并发症。

改良后的方法处理输尿管上段结石时，结石不易漂移入肾盂，结石一期清除率高，安全方便可行性强，尤其适用于没有输尿管软镜的基层医院。

To explore the clinical efficacy of the modified ureteral rigid holmium laser lithotripsy for the treatment of upper ureteral calculi.

A total of 115 patients with unilateral unilateral ureteral stones (the distances from stones to the ureteropelvic junction≤5 cm) were selected from May 2015 to May 2017 in the Urology Department of the First Hospital of Shanxi Medical University. The modified ureteral lithotripsy (modified group, 72 cases) and traditional ureteral lithotripsy (control group, 43 cases) were performed respectively. Modified group:Inlet valve and outlet valve of ureteroscope were connected to water inlert and vacuum extractor respectively by tee joint. Patients were in the dorsal elevated and oblique supine position. Ureteroscope was catheterized with the guiding of plugging device. Operator controlled the speed of water ingress. 200 μm-fine-fiber was used during lithotripsy. After adequate drainage, furosemide was intravenous injected.There was no significant difference in age, sex, stone side, degree of hydronephrosis, distance between stones from ureteropelvic junction and stone size (P>0.05). One-stage stone clearance rate and drift rate were compared between two groups.

The stone clearance rate was 93.06% (67/72) in the modified group and 62.79% (27/43) in the control group. The difference between the two groups was statistically significant (χ²=16.52, P<0.05). The drift rate in modified group was 5.56% (4/72), and that in the control group was 41.86% (18/43). There was a statistically significant difference between the two groups (χ²=22.94, P<0.05). There was no ureteral perforation, ureteral avulsion and other serious complications during intraoperative or postoperative period.

When the improved method is used to treat upper ureteral stones, stones do not easily migrate into the renal pelvis. The clearance rate of stones in the first stage is high, and it is safe, convenient, and feasible. It is particularly suitable for primary hospitals without soft ureteroscopes.