经尿道Peel-away 鞘输尿管镜与经尿道输尿管镜治疗膀胱结石的疗效比较

Efficacy between ureteroscopic via urethral Peel-away sheath and transurethral ureteroscopy in treating bladder calculi: A comparative study

摘要:

目的 比较经尿道Peel-away 鞘输尿管镜与经尿道输尿管镜治疗膀胱结石的效果。方法 将该 科2013 年1 月-2015 年12 月76 例膀胱结石按随机原则分为：A 组（经尿道Peel-away 鞘输尿管镜膀胱碎石术） 45 例；B 组（经尿道输尿管镜膀胱碎石术）31 例。结果 76 例膀胱结石均获一次性碎石取石成功。碎石时间： A 组（17.8±5.9）min，B 组（22.7±8.3）min，差异有统计学意义（t =2.96，P =0.004）；清石时间：A 组（12.6± 4.9）min，B 组（24.5±5.3）min，差异有统计学意义（t =9.90，P =0.000）；术中尿道黏膜损伤：A 组（1.0±0.5）分， B 组（2.1±0.4）分，差异有统计学意义（t =9.47，P =0.000）；VAS 评分：A 组（1.9±0.6）分，B 组（2.6±0.6）分， 差异有统计学意义（t =4.72，P =0.000）；留置导尿管时间：A 组（1.0±0.2）d，B 组（1.4±0.9）d，差异有统 计学意义（t =2.59，P =0.012）；住院费用：A 组（7 437.4±356.7）元，B 组（7 296.8±333.8）元，差异无统 计学意义（t =-1.73，P =0.087）。两组术中无膀胱大出血、穿孔和破裂等并发症，无中转开放手术。术后并发 症：B 组发生术后泌尿系感染1 例，经口服抗生素治疗后痊愈；A 组发生术后尿潴留1 例，B 组5 例，差异有 统计学意义（χ2=6.43，P =0.011）。随访情况：失访13 例，余63 例随访6 ～ 12 个月，两组各有1 例老年男 性患者因前列腺增生导致尿潴留；余患者均无再发结石，无尿道狭窄。通过统计分析结果，发现A 组在碎石 时间、清石时间、尿道黏膜损伤、术后疼痛和术后留置导尿管时间等方面较B 组具有明显优势。结论 经尿 道Peel-away 鞘输尿管镜与经尿道输尿管镜治疗膀胱结石疗效无明显差异。经尿道Peel-away 鞘输尿管镜在 碎石时间、清石时间及避免术中损伤尿道黏膜方面更优，两组手术费用无明显差异。经尿道Peel-away 鞘输 尿管镜是一种值得推广的内镜膀胱碎石手术方法。

Abstract:

Objective To compare the effectiveness of ureteroscopic via urethral Peel-away sheath and transurethral ureteroscopy in treatment of bladder calculi. Methods Clinical data of 76 cases of bladder calculi patients were collected from January 2013 to December 2015. All the patients were randomly divided into two groups: Group A was performed by ureteroscopic lithotripsy via urethral Peel-away sheath (n = 45). Group B was transurethral ureteroscopic lithotripsy (n = 31). Results 76 cases of bladder calculi were successfully treatedby one-time lithotripsy. Lithotripsy time: group A was (17.8 ± 5.9) min, group B was (22.7 ± 8.3) min (t = 2.96, P = 0.004); stone clearance time: group A (12.6 ± 4.9) min, group B (24.5 ± 5.3) min (t = 9.90, P = 0.000); Intraoperative urethral mucosa injury : group A (1.0 ± 0.5), group B (2.1 ± 0.4) (t = 9.47, P = 0.000); VAS score: group A (1.9 ± 0.6), group B (2.6 ± 0.6) points (t = 4.72, P = 0.000); indwelling catheter time: group A (1.0 ± 0.2) d, B group (1.4 ± 0.9) d (t = 2.59, P = 0.012); There was no significant difference in hospitalization expense, group A was (7 437.4 ± 356.7), group B was (7 296.8 ± 333.8) (t = -1.73, P = 0.087). There were no complications such as hemorrhage, perforation and rupture of the 2 groups, without convertion to open surgery either. After the treatment of oral antibiotic, 1 case of postoperative urinary tract infection was cured in group B. In our study, case of postoperative urinary retention was 1 in group A, versus 5 in group B, with statistical difference (χ2 = 6.43, P = 0.011). Follow up: 13 patients were lost to follow-up, the other patients were followed up for 6 ~ 12 months. There was 1 case of elderly male patient with urinary retention due to BPH in each of the 2 groups, the other patients had no recurrence of calculus. By analyzing the statistical results, it was found that the experimental group had obvious advantages over the control group in the lithotripsy time, stone clearance time, urethral mucosa injury, postoperative pain and postoperative indwelling catheter time. Conclusion There is no significant difference in efficacy of the treatment of bladder calculi between ureteroscopic via urethral Peel-away sheath and transurethral ureteroscopy. However, our study shows the Peel-away ureteroscopy has the advantages of shorter lithotripsy time, shorter time of stone clearance and less injury of urethra mucosa menbrane, there was no significant difference in operation cost between two groups. Therefore, Ureteroscopic via urethral Peel-away sheath is an effective method for endoscopic bladder lithotripsy.