新型负压吸引经尿道输尿管一体硬镜碎石术的临床应用研究

Clinical application of a new type transureteral lithotripsy integrated suction and semi-rigid ureteroscope

摘要:

目的 探究新型负压吸引经尿道输尿管一体硬镜碎石术在输尿管结石疾病中的效果及临床价值。方法 选取2018年5月—2019年10月在赣州市人民医院泌尿外科行输尿管结石手术的患者157例，随机分为A组53例、B组46例及C组58例。A组采用传统经尿道输尿管硬镜碎石术，B组采用带鞘负压吸引经尿道输尿管硬镜碎石术，C组采用新型负压吸引经尿道输尿管一体硬镜碎石术。比较3组患者的术前资料、一期手术成功率、手术时间、住院时间、术后30 d清石率、并发症Clavien系统分级等情况。结果 144例经尿道输尿管镜碎石手术一期完成，其余13例因输尿管狭小无法上鞘或进镜改为其他手术方式。3组患者的术前资料比较差异无统计学意义（P >0.05）；一期手术成功率B组低于A、C组（P <0.05）；手术时间C组较A、B组短（P <0.05），住院时间C组较A、B组少（P <0.05）；术后 30 天清石率A组低于B、C组（P <0.05）；A、B、C组患者总并发症发生率差异无统计学意义（P >0.05）。结论 新型负压吸引经尿道输尿管一体硬镜碎石术比其余两种具有一定的优势，能降低患者手术时间和住院时间，具有较好的临床价值，值得推广。

Abstract:

Objective To explore the effect and clinical value of a new type of transurethral integrated semi-rigid ureteroscopic lithotripsy for ureteral calculi.Methods From May 2018 to October 2019, 157 patients who underwent surgery for ureteral calculi in our department were randomly divided into 53 cases of group A, 46 cases of group B, and 58 cases of group C. Group A used traditional transurethral semi-rigid ureteroscopic lithotripsy, group B used a suctioning semi-rigid ureteroscopic lithotripsy with a sheath being connected to a vacuum device, and group C used a new type of suctioning integrated semi-rigid ureteroscopic lithotripsy. The preoperative data, success rate of one surgery, operation time, length of hospital stay, postoperative stone clearance rate, and complications of Clavien system classification were compared for the three groups.Results One hundred and forty-four cases of transureteral lithotripsy were completed in one stage, and the remaining 13 cases were converted to other surgical methods due to ureteral stricture leading difficulty in placing a suctioning sheath or entering the ureteroscope. There was no statistically significant difference in the preoperative data among the three groups of patients (P > 0.05). Compared with groups A and C, group B had a lower one-stage operation success rate (P <0.05). Compared with groups A and B, Group C had a shorter operation time (P < 0.05) and fewer hospitalization days (P < 0.05). Compared with groups B and C, group A had a lower rate of stone clearance at 30 days after surgery (P < 0.05). There was no significant difference in the incidence of total complications among the three groups of patients (P > 0.05).Conclusions Compared with the other two types, the new type suctioning integrated semi-rigid ureteroscopic lithotripsy has certain advantages, significantly reducing the operation time and the length of hospital stay for the patients, and improving the minimally invasive surgery level for patients with upper urinary calculi and economic operation of the hospital. It has good clinical value and is worthy of promotion.