输尿管软镜下钬激光治疗不同大小肾下盏结石的比较分析*

Flexible ureterorenoscope holmium laser lithotripsy for treatment of different sizes lower pole caliceal stones*

摘要:

目的 对比输尿管软镜下钬激光治疗不同大小肾下盏结石的效果。方法 2011年8月-2015年4月选择在该院进行诊治的肾下盏结石140例，其中最大结石直径>2.0 cm的有40例（观察组），最大结石直径≤2.0 cm的有100例（对照组），所有患者都给予输尿管软镜下钬激光治疗，观察与比较预后情况。结果 观察组术后3天和1个月的碎石成功率为80.0%和97.5%，对照组为95.0%和98.0%，观察组术后3天的碎石成功率明显低于对照组（P <0.05）。观察组的手术时间与术后住院时间明显高于对照组（P <0.05）。观察组术后1个月的肺部感染、血尿和尿外渗等并发症发生情况明显高于对照组（P <0.05）。观察组术后3天的血肌酐含量明显高于术前（P <0.05），且明显高于对照组（P <0.05），两组其他时间点的血肌酐含量对比差异均无统计学意义（P >0.05）。结论 相对于小型肾下盏结石，输尿管软镜下钬激光治疗大型肾下盏结石的碎石成功率有所下降，对于患者也有一定的创伤，肾功能状况也有所波动，术后并发症也比较多，在临床上要慎重选择。

Abstract:

Objective To compare the effects of flexible ureterorenoscope holmium laser for treatment of different sizes lower pole caliceal stones. Methods 140 patients with lower pole caliceal stones from August 2011 to April 2015 were enrolled, 40 patients were divided into observation group which the largest stone diameter > 2.0 cm, 100 patients were divided into control group which the largest stone diameter ≤ 2.0 cm. All these patients received flexible ureterorenoscope holmium laser treatment. Then we observe and compare the prognosis. Results The postoperative 3 d and 1 month of gravel success rates were 97.5 % and 80.0 % in observation group, while the control group were 98.0% and 95.0%. The postoperative 1 month of gravel success rates in observation group was significantly lower than that in control group (P < 0.05). The operative time and postoperative hospital stay in observation group were significantly higher than control group (P < 0.05). The postoperative 1 month complications of lung infection, hematuria, urinary extravasation and so on in observation group were significantly higher than that in control group (P < 0.05). The postoperative 3 d creatinine contents in observation group were significantly higher than preoperative (P < 0.05), and significantly higher than that in control group (P < 0.05). The creatinine contents compared between the two groups at other time points were not statistically significant (P > 0.05). Conclusion Compared with small lower pole caliceal stones, the success rate of flexible ureterorenoscope holmium laser treatment of large lower pole caliceal stones is declined, the patients also have some trauma, and the renal function is also fluctuate, postoperative disease is relatively higher that clinically to be carefully chosen.