【摘要】 目的对比分析输尿管硬镜与输尿管软镜处理输尿管中上段结石的疗效。方法回顾性分析安医大一附院2016年1月—2016年12月收治的147例输尿管中上段结石患者。其中硬镜组93例;软镜组54例。比较两组术后结石清除率,并发症及碎石效果。结果硬镜87例获一期手术成功,其中6例术中结石上移二期行ESWL术;手术时间16～72 min,平均(38.08±14.64)min;术后住院时间2～5 d,平均(2.87±0.78)d;术后均未发生并发症。术后1个月复查:显示结石清除率为89.24%;54例软镜均获手术一期成功。手术时间28～83min,平均(47.61±11.77)min,术后住院时间1～2 d,平均(1.31±0.47)d。术后1个月复查显示结石清除率为100%,未见并发症发生。4例术后残留结石,行ESWL治疗,2周后结石排净。结论输尿管镜钬激光碎石术是处理输尿管中上段结石的有效手段,其中硬镜普及率较高,而且患者手术费用较低;软镜普及率低、手术费用高、维修费高、学习周期长;但软镜在手术后腰痛、血尿、结石清除率、住院时间方面优于硬镜。更多还原

【Abstract】 Objective To compare the effect of rigid ureteroscopic lithotripsy and flexible ureteroscopic lithotripsy in the treatment of upper and middle ureteral stones. Methods We retrospectively analyzed 147 patients with upper and middle ureteral stones from January 2016 to December 2016 in The First Affiliated Hospital of Anhui Medical University. Including rigid ureteroscopic lithotripsy treatment in 93 cases, while 54 cases were treated by flexible ureteroscopic lithotripsy. CT scan was used to analyze the postoperative stone clearance rates, and the complications were compared. Results 87 cases were succeed undergone rigid ureteroscopic lithotripsy, and 6 cases were treated with extracorporeal shock wave lithotripsy due to the migration of the Stone fragments. The operation time was 16 ～ 72 min with an average time of(38.08±14.64)min, and the hospitalization days were 2 ～ 5 d with an average of(2.87±0.78)d. No postoperative complications such as ureteral perforation, rupture, mucosal avulsion were obtained. One month later, double J tubes were removed and KUB(plain film of kidney-ureter-bladder) accompany with kidney CT scan showed a stone clearance rate was 89.24 %. For the other group, 54 cases were all successfully treated with flexible ureteroscopic lithotripsy. The operation time was 28 ～ 83 min with an average time of(47.61±11.77)min. The postoperative hospitalization days were 1 ～ 2 d, with an average of(1.31±0.47)days. One month after the review of KUB and kidney CT scan and removal of double J tube, the results show that the removal rate of 100%. No serious complications such as pus kidney, infectious shock,ureteral perforation, acute renal failure and so on. Conclusions Ureteroscopic holmium laser lithotripsy is an effective approach to treating upper and middle ureteral stones in the upper and middle ureter, in which the rigid rather than flexible ureteroscopic lithotripsy is more prevalent and economic. Besides, flexible ureteroscopes often need higher maintenance cost and longer learning curve. However, flexible ureteroscopic lithotripsy possessed the advantages in the postoperative back pain, hematuria, stone clearance, hospitalization days compared with the rigid ureteroscopic lithotripsy.更多还原