封堵取石导管联合钬激光治疗输尿管结石的对比研究

Comparative study of ureteral occlusion device combined with ureteroscopic holium laser lithotripsy in the treatment of ureteral calculi

摘要:

目的：评估英诺伟TMIVX－SC10封堵取石导管在输尿管镜取石术中应用的有效性及安全性。方法：2013年1月至8月于我院就诊的单侧输尿管结石并行输尿管镜检患者299例，随机分为２组，应用封堵取石导管141例（A组），未应用158例（B组）。比较２组患者的碎石成功率、结石清除率、手术时间、手术并发症发生率。结果：２组的总体碎石成功率相当，A组为90.1%，B组为82.3%，差异无统计学意义（P=0.053）；对输尿管上段结石A组为81.6%，B组为62%，差异有统计学意义（P=0.046）；对输尿管中下段结石的成功率２组比较无统计学意义（P=１.000，0.59）；对成功施行输尿管镜碎石的例数中A组的平均手术时间为（36.2±13.4） min，B组为（44.9±28.7） min，差异有统计学意义（P=0.002）；上段结石A组的手术时间为（39.2±12.0） min，B组为（53.3±26.2） min，差异有统计意义（P=0.010）；中段结石A组的手术时间为（43.0±14.1） min，B组为（45.3±20） min，差异无统计意义（P=0.754）；下段结石A组的手术时间为（34.1±13.6） min，B组为（41.1±28.5） min，差异有统计意义（P=0.047）；A组输尿管上段的结石的清除率为96.8%，B组为80.6%，差异无统计学意义（P=0.104）；中下段结石2组比较无明显差异（P=1.000，0.479）。2组并发症发生率比较无统计学差异。结论：使用结石封堵取石导管能显著提高输尿管上段结石经输尿管镜碎石的成功率，能显著缩短输尿管镜碎石术的手术时间。

Abstract:

Objective：To evaluate the clinical efficacy and safety of INNOVEX TMIVX-SC10 ureteral occlusion device in the uretero－scopic holmium laser lithotripsy. Methods：Totally 299 patients with unilateral ureteral calculi from January 2013 to August 2013 were enrolled in this study. They were randomly divided into 2 groups，group A（141 cases） applying ureteral occlusion device and group B（158 cases） not applying ureteral occlusion device during ureteroscopic holmium laser lithotripsy. The success rate，calculus elimination rate，average operation time and complications were compared. Results：There was no statistically significant difference in overall calculi free rate between group A（90.1%） and group B（82.3%）（P=0.053）. There were statistically significant differences in calculi free rate for upper urethral calculi between group A（81.6%） and group B （62.0%）（P=0.046），but there was no difference for lower urethral calculi between two groups（P=1.000，0.590）. Average operation time of success cases were （36.2±13.4） min and （44.9±28.7） min with statically differences between two groups（P=0.002）. Average operation time of upper ureteral calculi stone were （39.2±12.0） min and （53.3±26.2） min with statically differences between two groups（P=0.010）. Average operation time of middle urethral calculi were （43.0±14.1） min and （45.3±20.0） min with statically differences between two groups（P=0.754）. Average operation time of lower ureteral calculi were （34.1±13.6） min and （41.1±28.5） min with statically differences between two groups（P=0.047）. Calculi free rates for upper urethral calculi in two groups were 96.8% and 80.6%，without statistically significant difference（P=0.104） and no statistically significant difference was found in calculi free rates for middle and lower ureteral calculi between two groups（P=1.000，0.479）. There was no difference in complication incidence between two groups. Conclusion：Ureteral occlusion device can significantly increase success rate and calculi free rate for upper ureteral calculi and can reduce operation time of ureteroscopy lithotripsy.