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目的比较采用钬激光碎石术与体外冲击波碎石术(ESWL)治疗输尿管结石的有效性和安全性。方法采用输尿管镜钬激光碎石术治疗输尿管结石80例,其中结石直径≥1 cm 36例(36侧),<1 cm者44例(44侧)。采用ESWL治疗82例(85侧),其中结石直径≥1 cm者40例(40侧),<1 cm者42例(45侧)。比较两组手术时间、结石排净率、手术并发症发生率等指标的差异。结果对直径≥1 cm和<1 cm的输尿管结石钬激光碎石术治疗平均手术时间分别为(56.0±2.3)min和(39.0±1.8)min,与ESWL组的平均手术时间[(73.0±4.5)min和(54.0±2.1)min]比较,差异有统计学意义(P<0.01);钬激光碎石术对直径≥1 cm的输尿管结石1个月结石排净率为89.5%,高于ESWL的65%,差异有显著性统计学意义P<0.01);对直径<1 cm的输尿管结石钬激光碎石术和ESWL的1个月结石排净率分别为92.9%和83.3%,两者间的差异无统计学意义(P>0.05)。钬激光碎石术组并发症发生率为3.75%(3/80),ESWL组无明显并发症发生。结论输尿管镜钬激光碎石术对直径≥1 cm的输尿管结石的疗效明显优于ESWL,差异有统计学意义(P<0.05);而直径<1 cm的结石二者疗效的差异无统计学意义(P>0.05)。因此对直径≥1 cm及输尿管中下段结石宜首选输尿管镜钬激光碎石术,而对直径<1 cm及输尿管上段结石宜首选ESWL。
Objective To compare the efficacy and safety of holmium laser lithotripsy and extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral calculi. Methods Ureteroscopic holmium laser lithotripsy was used to treat 80 cases of ureteral calculi, including 36 cases (36 sides) with diameter ≥1 cm and 44 cases (44 sides) <1 cm. There were 82 cases (85 sides) treated with ESWL, of which 40 cases (40 sides) with diameter ≥1 cm and 42 cases (45 sides) <1 cm. Comparison of two groups of operation time, stone discharge rate, the incidence of complications and other indicators of differences. Results The mean operative time was (56.0 ± 2.3) min and (39.0 ± 1.8) min for ureteral calculi with ureteral stones ≥1 cm and <1 cm, respectively. The mean operative time was (73.0 ± 4.5) days in ESWL group ) and (54.0 ± 2.1) min], the difference was statistically significant (P <0.01). Holmium laser lithotripsy showed a clear stone clearance rate of 89.5% at 1 month for ureteral stones with a diameter of more than 1 cm, which was higher than ESWL (P <0.01). The stone clearance rate of ureteral stones with holmium laser lithotripsy and ESWL of diameter less than 1 cm were 92.9% and 83.3% respectively, the difference between the two groups was statistically significant The difference was not statistically significant (P> 0.05). Holmium laser lithotripsy group complication rate was 3.75% (3/80), ESWL group no significant complications. Conclusions Ureteroscopic holmium laser lithotripsy is superior to ESWL in ureteral stones more than 1 cm in diameter (P <0.05), while there is no significant difference in curative effect between stones with diameter <1 cm (P> 0.05). Therefore, the diameter ≥ 1 cm and ureteral stones in the lower ureteroscopic ureteroscopic ureteroscopy preferred, and the diameter of <1 cm and upper ureteral stones should be preferred ESWL.