Analysis of factors influencing the efficacy of rigid ureteroscopic lithotripsy in treating upper ureteral calculi

doi:10.3877/cma.j.issn.1674-3253.2020.06.009

Abstract

Abstract:

Objective

To explore the influencing factors on the efficacy of holmium laser lithotripsy under rigid ureteroscope for upper ureteral calculi.

Methods

From January 2012 to December 2018, 1704 cases of upper ureteral calculi treated by rigid ureteroscopic holmium laser lithotripsy were analyzed retrospectively. According to operative results, they were divided into successed group (n=1 560) and failed group (n=144). Two groups of parameters were compared, and analyzed related factors under logistic regression analysis about the success rate of holmium laser lithotripsy under rigid ureteroscope for upper ureteral calculi.

Results

In 1 704 cases, 1 560 cases underwent at one-stage lithotripsy successfully, and total success rate was 91.5%. There were significant effects in success rate of lithotripsy on the side and dwelling time of the calculi, the width of collecting system, the CT value and number of calculi, and with or without difficult access of ureteroscope (P<0.05). However, the presence of difficult access for the ureteroscope to reach the calculi was an independent influencing factor on the success, which was negatively correlated with the success of one-stage lithotripsy (regression coefficient=-1.233, P<0.01).

Conclusion

The high success rate of holmium laser lithotripsy under rigid ureteroscope for upper ureteral calculi could be achieved. Its efficacy was related to a variety of factors, and difficult access or not might be the main influence factor. Rigid ureteroscopic holmium laser lithotripsy is still an ideal choice for minimally invasive surgical treatment for upper ureteral calculi.

Key words: Rigid ureteroscope, Ureteral calculi, Ureteroscopy, Influential factor, Difficult access

Weili Wu, Hua Shen, Kai Liao, Hongbo Yu, Hongfei Wu. Analysis of factors influencing the efficacy of rigid ureteroscopic lithotripsy in treating upper ureteral calculi[J]. Chinese Journal of Endourology(Electronic Edition), 2020, 14(06): 439-443.

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References 17

[1]	那彦群, 叶章群, 孙颖浩, 等. 中国泌尿外科疾病诊断治疗指南手册[M]. 2014版. 北京:人民卫生出版社, 2013: 129-147.
[2]	Perez CE, Osther P, Jinga V, et a1. Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the Clinical Research Office of the Endourological Society ureteroscopy global study[J]. Eur Urol, 2014, 66(1): 102-109.
[3]	叶宗岳, 张新明, 吴洪涛, 等. 输尿管软镜联合钬激光碎石术治疗上段尿路结石的疗效观察[J]. 国际泌尿系统杂志, 2016, 36(3): 324-326.
[4]	周逢海, 吕海迪, 郭秀全, 等. 经尿道输尿管软镜钬激光治疗肾和输尿管上段结石[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2014, 8(2): 21-24.
[5]	张学齐, 郭吉楠, 杨江根, 等. 输尿管软镜联合钬激光碎石术治疗上尿路结石临床观察[J]. 现代中西医结合杂志, 2016, 25(4): 354-356.
[6]	潘兆君, 黄伟佳, 高兴成, 等. 硬性输尿管镜术中入镜困难的处理（附72例报告）[J]. 中国微创外科杂志, 2006, 6(8): 604-605.
[7]	阮建中, 万胜红, 晏增亚, 等. 输尿管上段结石的微创治疗(附600例报告)[J]. 中国微创外科杂志, 2011, 11(10): 930-931.
[8]	金一. 输尿管结石应用钬激光碎石术与体外冲击波碎石术的疗效比较[J]. 当代医学, 2019, 25(5): 88-90.
[9]	刘景波, 闫永吉, 冯营营, 等. 三种方法治疗直径大于1 cm单发输尿管上段结石的比较研究[J]. 微创泌尿外科杂志, 2018, 7(3): 181-184.
[10]	杨晗杰, 李琴. 影响输尿管镜碎石术治疗输尿管结石疗效的相关因素分析[J]. 现代泌尿外科杂志, 2013, 18(1): 85-86.
[11]	哈姆, 雪艳, 罗斯满, 等. 影响输尿管结石术患者碎石成功率的危险因素分析[J]. 实用医院临床杂志, 2019, 16(3): 139-141.
[12]	Yoshida T, Inoue T, Omura N, et al. Ureteral wall thickness asa preoperative indicator of impacted stones in patients with ureteralstones undergoing ureteroscopic lithotripsy[J]. Urol, 2017, 106(8): 45-49.
[13]	Leijte JA, Oddens JR, Lock TM. Holmium laser lithotripsy for ureteral calculi: predictive factors for complications and success[J]. J Endourol, 2008, 22(2): 257-260.
[14]	Elsheemy MS, Maher A, Mursi K, et al. Holmium: YAG laser ureteroscopic lithotripsy for ureteric calculi in children: predictive factors for complications and success[J]. World J Urol, 2014, 32(4): 985-990.
[15]	赵慧, 韩胜, 杜凌云, 等. 经皮肾穿刺造瘘术与输尿管镜碎石术对输尿管结石致急性梗阻性肾损伤的疗效及安全性分析[J]. 山西医药杂志, 2019, 48(10): 1198-1200.
[16]	辛玉宏, 赵国平, 张彩虹, 等. 输尿管封堵取石导管在输尿管上段结石中的应用[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(6): 380-383.
[17]	廖凯, 沈华, 张斌, 等. 输尿管镜进镜困难原因分析及对策:附165例报告[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2014, 8(3): 225-226.

组别	性别		结石侧别		结石数目		麻醉方式		上镜困难		使用阻拦器
组别	男	女	左侧	右侧	单发	多发	椎管内麻醉	全身麻醉	否	是	否	是
成功组	1224	336	840	720	1464	96	1248	312	1236	324	1258	302
失败组	0114	030	090	054	0120	24	0108	036	0072	072	0123	021
χ²值	0.039		3.982		22.257		2.028		63.144		0.310
P值	0.844		0.046		<0.001		0.154		<0.001		0.578

组别	性别		结石侧别		结石数目		麻醉方式		上镜困难		使用阻拦器
组别	男	女	左侧	右侧	单发	多发	椎管内麻醉	全身麻醉	否	是	否	是
成功组	1224	336	840	720	1464	96	1248	312	1236	324	1258	302
失败组	0114	030	090	054	0120	24	0108	036	0072	072	0123	021
χ²值	0.039		3.982		22.257		2.028		63.144		0.310
P值	0.844		0.046		<0.001		0.154		<0.001		0.578

参数	例数	年龄	结石停留时间（d）^△	集合系统宽度（mm）^△	结石CT值（HU）^△	结石长径（mm）	激光能量（J）	激光频率（Hz）	激光功率（W）
成功组	1560	44.50±13.27	7.93（16.63）	17（15）	684（436）	9.67±2.78	0.79±0.12	30.29±2.20	23.65±2.21
失败组	0144	47.96±12.09	9.38（20.51）	16（13）	610（435）	10.04±3.48	0.79±0.04	30.00±1.45	23.71±0.98
统计值		t=-3.259	Z=-1.019	Z=-1.289	Z=-2.198	t=-1.247	t=-1.133	t=2.171	t=-0.628
P值		0.220	0.308	0.197	0.028	0.541	0.837	0.530	0.892

参数	例数	年龄	结石停留时间（d）^△	集合系统宽度（mm）^△	结石CT值（HU）^△	结石长径（mm）	激光能量（J）	激光频率（Hz）	激光功率（W）
成功组	1560	44.50±13.27	7.93（16.63）	17（15）	684（436）	9.67±2.78	0.79±0.12	30.29±2.20	23.65±2.21
失败组	0144	47.96±12.09	9.38（20.51）	16（13）	610（435）	10.04±3.48	0.79±0.04	30.00±1.45	23.71±0.98
统计值		t=-3.259	Z=-1.019	Z=-1.289	Z=-2.198	t=-1.247	t=-1.133	t=2.171	t=-0.628
P值		0.220	0.308	0.197	0.028	0.541	0.837	0.530	0.892

参数	例数	结石停留时间（d）				集合系统宽度（mm）				结石CT值（HU）		结石长径（mm）
参数	例数	<14	≥14	<42	≥42	<20	≥20	<30	≥30	<1 000	≥1 000	<10	≥10
成功组	1560	1308	252	1554	06	1062	498	1524	72	1374	186	918	642
失败组	0144	0132	012	0132	12	0084	060	0084	24	0108	036	084	060
χ²值		6.158		79.693		5.683		59.683		19.896		0.014
P值		0.013		<0.001		0.017		<0.001		<0.001		0.905

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