何峰 满立波 李贵忠 等

[摘要] 目的 探討输尿管硬镜联合软镜治疗输尿管上段结石的临床效果。 方法 选择北京积水潭医院泌尿外科2011年2月～2015年2月收治的66例输尿管上段结石患者，根据随机数字表法分为治疗组与对照组，每组各33例，治疗组给予输尿管硬镜联合软镜下碎石治疗， 对照组给予输尿管硬镜下碎石治疗，观察两组围手术指标、并发症与随访复发情况。 结果 所有患者顺利完成手术，治疗组的碎石时间、结石排净时间与术后住院时间都明显短于对照组（P < 0.05）。术后14 d经过观察，治疗组的治疗有效率为93.9%，对照组为78.8%，差异有统计学意义（P < 0.05）。治疗组术后14 d的恶心呕吐、肺部感染、疼痛、输尿管损伤等并发症发生情况明显少于对照组（P < 0.05）。所有患者术后随访6个月，治疗组的复发率为3.0%（1/33），对照组为15.2%（5/33），治疗组术后复发率明显低于对照组（P < 0.05）。 结论 输尿管硬镜联合软镜治疗输尿管上段结石具有很好的微创性，能提高治疗效果，并且减少术后并发症的发生，有很好的应用效果。

[关键词] 输尿管硬镜；输尿管软镜；输尿管上段结石；并发症；复发

[中图分类号] R693+.4 [文献标识码] A [文章编号] 1673-7210（2016）02（b）-0141-04

Clinical effect analysis of ureteroscopic combined flexible ureteroscope for ureteral calculi patients

HE Feng MAN Libo LI Guizhong LIU Ning

Department of Urinary Surgery， Beijing Jishuitan Hospital， Beijing 100035， China

[Abstract] Objective To investigate the clinical effects of ureteroscopic combined flexible ureteroscope for the ureteral calculi patients. Methods 66 patients with ureteral calculi in the department of Urinary Surgery of Beijing Jishuitan Hospital from February 2011 to February 2015 were selected and divided into treatment group and control group， with 30 cases in each group according to random number table method. The treatment group were received ureteroscopic combined flexible ureteroscope therapy， the control group were only received ureteroscopic therapy. The perioperative treatment， complications and follow-up recurrence were observed. Results All operations were successfully completed， but the stone drain time， gravel time and hospital stay in the treatment group were significantly less than those of the control group （P < 0.05）. Postoperative 14 d through observation， the effective rates in the treatment group and the control group were 93.9% and 78.8%， Difference was statistically significant （P < 0.05）. The postoperative 14 d nausea and vomiting， lung infection， pain， ureteral injury complications in the treatment group were significantly less than those of the control group （P < 0.05）. All patients were followed up for 6 months， the relapse rate in the treatment group was 3.0% （1/33）， and the control group were 15.2% （5/33）， the treatment group recurrence rate was significantly lower than that of the control group （P < 0.05）. Conclusion Ureteroscopic combined flexible ureteroscope for ureteral calculi patients has good minimally invasive， can improve the therapeutic effect and reduce the incidence of postoperative complications， which has very good application effects.

[Key words] Ureteroscopic； Flexible ureteroscope； Ureteral calculi； Complications； Recurrence

输尿管结石是泌尿外科比较常见的疾病，临床症状主要表现为肾积水、膀胱刺激症、上腹部疼痛、尿频、尿急等[1-2]。如果长期不治疗会对患者肾脏功能造成严重损害，严重的会危及生命[3-4]。在输尿管结石类型中，输尿管上段结石比较多，其治疗方法包括经皮肾镜碎石术、体外冲击波碎石术和输尿管镜碎石术等，其中输尿管镜碎石术具有碎石效率高与复发率低等特点[5-6]。其中输尿管软镜是一项新兴的腔镜技术，尤其是光纤技术的发展、工作通道的出现和主动弯曲技能的设计，使得输尿管软镜的应用进一步拓展。特别是输尿管软镜可以避免或减少输尿管硬镜下碎石导致结石上行所带来的并发症[7]。并且具有可到达每个结石进行诊治、可重复治疗等优点，其应用越来越受到临床医师的重视[8]。……