输尿管镜联合套石篮或NTrap网篮治疗输尿管上段结石的疗效分析

Efficacy of ureteroscopic pneumatic lithotripsy combined with stone basket or NTrap in the treatment of upper urethral calculi

摘要:

目的：研究套石篮或NTrap网篮在输尿管镜下碎石手术中防止结石上移的作用。方法：回顾性分析2011年6月至2013年10月192名因输尿管上段结石接受输尿管镜下气压弹道碎石手术病人的临床资料。将患者分为3组，第1组仅接受输尿管镜下气压弹道碎石（n=62），第2组为联合使用套石篮和气压弹道碎石（n=64），第3组为联合使用NTrap网篮与气压弹道碎石（n=66）。比较3组间手术时间、术后住院时间、结石上移率、碎石成功率、术后1月结石清除率、术后发热、输尿管损伤发生率。结果：第1、2、3组病人的平均年龄分别为（36.5±12.9）、（35.4±13.5）、（34.2±12.7）岁，无统计学差异（P=0.058）。第1、2、3组病人结石大小分别为：（6.5±1.65）、（6.7±2.04）、（7.1±1.84） mm，无统计学差异（P=0.097）。第1、2、3组的手术时间分别是（25.4±13.9）、（36.5±10.6）、（34.3±8.7） min，第1组的手术时间较短。第1、2、3组结石上移率为12.9%、4.6%、6.1%，第1组结石上移率与其他２组比较有统计学差异。第1，2，3组结石清除率分别是82.2%，90.6%和90.9%。与第1组相比，第2组和第3组的结石清除率明显提高。3组间的术后住院时间、发热及输尿管损伤无统计学差异。结论：套石篮和NTrap网篮作为一个有用的工具应用于输尿管镜下碎石术中，可以防止结石的上移，而且有助于清石过程的安全。

Abstract:

Objective：To determine the role of the stone basket or NTrap in blocking the upward movement of calculi during uretero－scopic lithotripsy. Methods：The clinical data of 192 patients who underwent ureteroscopic lithotripsy for upper urethral calculi from June 2011 to October 2013 were retrospectively analyzed. All patients were divided into three groups：62 patients who underwent ure-teroscopic pneumatic lithotripsy were assigned to Group 1，64 patients who underwent ureteroscopic pneumatic lithotripsy combined with the stone basket were assigned to Group 2 and 66 patients who underwent ureteroscopic pneumatic lithotripsy combined with the NTrap were assigned to Group 3. The operation time，hospitalization duration，success rate，and pre-and postoperative complications were compared retrospectively among three groups. Results：There was no significant difference among three groups in terms of mean age of the patients and the mean size of the calculi（P=0.058，P=0.097）. The mean operation time was （25.4±13.9），（36.5±10.6），（34.3±8.7） min respectively in Group 1，Group 2 and Group 3. The calculi retropulsion rate was 12.9%，4.6%，6.1% in Group 1，Group 2 and Group 3 respectively. The success rate of calculi removal was 82.2%，90.6% and 90.9% in Group 1，Group 2 and Group 3 respectively. The success rate of calculi removal was higher in Group 2 and Group 3 than in Group 1. There was no significant difference among three groups in terms of postoperative hospitalization duration and incidence of fever and urethra injury（P >0.05）. Conclusion：Stone basket and NTrap，used uring ureteroscopic lithotripsy，is considered to be an effective tool in blocking the upward movement of the calculi and is safe in calculi removal.