Clinical effect of occluder combined with holmium laser in the treatment of upper and middle ureteral calculi

doi:10.3877/cma.j.issn.1674-3253.2021.06.014

Abstract

Abstract:

Objective

To compare the clinical efficacy of patients with middle and upper ureteral calculi treated with and without occlude.

Methods

The clinical data of 97 patients with middle and upper ureteral calculi, from January 2017 to December 2019 in the Third Affiliated Hospital of Sun Yat-sen University, were retrospectively analyzed. The calculi were all unilateral and located above the sacroiliac joint plane. Depending on whether or not an occluder was used intraoperatively, they were divided into observation group (45 cases, with occluder) and control group (52 cases,without occluder). The operative time, intraoperative blood loss, stone escape, postoperative ambulation time, hospital stay, the stone clearance rate, incidence rates of postoperative complications, re-operation rate and quality of life [Short-Form Health Survey (SF-36)] before and after surgery were analyzed between the two groups.

Results

There was no significant difference in the operative time, intraoperative blood loss, postoperative ambulation time, postoperative hospital stay and re-operation rate at 3 months after operation between the two groups (P>0.05), but the escape rate of intraoperative stones in observation group was lower than that in control group (4.44% vs 23.08%)(P<0.05). 1 month after surgery, the stone removal rate in observation group was higher than that in control group (97.78% vs 84.62%)(P<0.05) and the total incidence rate of complications in observation group was lower than that in control group (11.11 % vs 30.37%) (P<0.05). The SF-36 scores of the two groups were significantly higher than those before surgery (P<0.05), even the score in observation group was significantly higher than that in control group (P<0.05).

Conclusion

Compared with simple ureteroscopy holmium laser lithotripsy, occluder combined with holmium laser in the treatment of middle and upper ureteral calculi can reduce the escape of intraoperative stones, improve the clearance rate of stones, reduce postoperative complications and improve the quality of life of patients.

Key words: Ureteral calculi, Holmium laser, Occluder, Stone removal rate, Complications, Quality of life

Shoudong Yang, Dongming Xiao, Jie Situ, Cheng Hu, Hao Zhang. Clinical effect of occluder combined with holmium laser in the treatment of upper and middle ureteral calculi[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(06): 511-515.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2021.06.014

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2021/V15/I06/511

Figures/Tables 4

References 17

[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):52-56.
[2]	朱澄村, 程帆, 饶婷, 等.输尿管软镜碎石术治疗上尿路结石的疗效和安全性[J]. 中华泌尿外科杂志, 2020, 41(1): 41-45.
[3]	张英晨, 蒋立城, 程玉峰, 等. 内置3 F输尿管导管在输尿管镜钬激光碎石术中的临床应用[J]. 临床泌尿外科杂志, 2018, 33(3): 229-231.
[4]	李保安, 何长海, 赵琪. NTrap阻石网篮与封堵器在输尿管镜钬激光碎石术治疗输尿管上段结石中的应用比较[J]. 现代泌尿外科杂志, 2018, 23(1): 30-33.
[5]	邓林, 张力, 李涵, 等. 输尿管软镜下钬激光碎石治疗肾结石的临床疗效及安全性分析[J]. 实用医院临床杂志, 2018, 15(5): 85-88.
[6]	杨嗣星, 廖文彪, 宋超, 等. 湖北省尿路结石患者的临床流行病学调查[J]. 中华泌尿外科杂志, 2018, 39(9): 647-650.
[7]	高让, 廖邦华, 陈云天, 等. 输尿管软镜钬激光碎石取石术治疗大于2 cm上尿路结石的疗效及安全性分析[J]. 重庆医科大学学报, 2018, 43(4): 57-61.
[8]	刘东, 玉苏甫·阿克木, 李凯, 等.输尿管软镜钬激光碎石术治疗婴幼儿上尿路结石[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(2): 99-102.
[9]	王跃, 曹沪春, 陈启平, 等.输尿管上段嵌顿性结石的三种微创手术疗效分析[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(4): 267-270.
[10]	段中阳, 李昕. 输尿管硬镜钬激光与斜仰卧位微创经皮肾镜治疗输尿管中上段结石疗效比较[J]. 临床军医杂志, 2018, 46(3): 255-257.
[11]	王战士, 陈静, 任黎刚, 等. 输尿管软硬镜联合钬激光碎石术治疗输尿管上段结石的疗效分析[J]. 浙江医学, 2018, 40(4): 75-77.
[12]	简毓, 吴曦, 张鹏, 等. 输尿管镜下钬激光联合封堵器碎石术与传统钬激光碎石术治疗输尿管结石临床研究[J]. 海南医学, 2017, 28(6): 904-906.
[13]	屈维龙, 汪益民, 尤志新. N-Trap拦截网篮或封堵器和无封堵装置应用于输尿管上段结石手术的效果比较[J].国际泌尿系统杂志, 2018, 38(5): 708-711.
[14]	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.
[15]	朱轶勇, 孙丰, 张琦, 等. 应用管路封堵器处理输尿管上段结石的随机对照研究[J]. 现代生物医学进展, 2017, 17(1): 166-169.
[16]	彭伟, 魏世平, 李辉明, 等. 输尿管镜联合封堵器治疗输尿管上段结石失败原因的分析及对策[J]. 临床外科杂志, 2019, 27(2): 116-117.
[17]	侯立男, 何士尧. 管路封堵器及顺行冲洗辅助输尿管镜治疗上段输尿管结石的应用研究[J]. 国际泌尿系统杂志, 2017, 37(2): 182-186.

组别	例数	性别(例)		年龄[岁，(±s)]	患侧(例)		结石位置(例)		结石直径[mm，(±s)]	肾积水(例)
组别	例数	男	女	年龄[岁，(±s)]	左	右	上段	中段	结石直径[mm，(±s)]	轻度	中度
观察组	45	29	16	43±90	25	20	18	27	14.9±3.1	26	19
对照组	52	33	19	44±10	29	23	18	34	14.3±3.3	30	22
统计值		χ²=0.920		t=0.514	χ²=0.983		χ²=0.300		t=0.874	χ²=0.993
P值		1.000		0.608	1.000		>0.05		0.405	1.000

组别	例数	性别(例)		年龄[岁，(±s)]	患侧(例)		结石位置(例)		结石直径[mm，(±s)]	肾积水(例)
组别	例数	男	女	年龄[岁，(±s)]	左	右	上段	中段	结石直径[mm，(±s)]	轻度	中度
观察组	45	29	16	43±90	25	20	18	27	14.9±3.1	26	19
对照组	52	33	19	44±10	29	23	18	34	14.3±3.3	30	22
统计值		χ²=0.920		t=0.514	χ²=0.983		χ²=0.300		t=0.874	χ²=0.993
P值		1.000		0.608	1.000		>0.05		0.405	1.000

组别	例数	手术时间(min)	术中出血量(ml)	术后下床活动时间(h)	术后住院时间(d)
观察组	45	33.1±7.4	20.6±5.6	5.1±1.8	3.8±0.7
对照组	52	30.8±8.4	18.5±6.4	5.0±1.9	4.1±0.8
t值		1.368	1.713	0.288	1.474
P值		0.175	0.090	0.774	0.144

组别	例数	手术时间(min)	术中出血量(ml)	术后下床活动时间(h)	术后住院时间(d)
观察组	45	33.1±7.4	20.6±5.6	5.1±1.8	3.8±0.7
对照组	52	30.8±8.4	18.5±6.4	5.0±1.9	4.1±0.8
t值		1.368	1.713	0.288	1.474
P值		0.175	0.090	0.774	0.144

组别	例数	发热	血尿	尿路感染	输尿管损伤	石街形成	并发症总数
观察组	45	1	20	1	1	0	05
对照组	52	5	6	2	2	1	16
χ²值		-	-	-	-	-	5.496
P值		0.211^a	0.279^a	1.000^a	0.590^a	1.000^a	0.019

Please choose a citation manager

Content to export