CAJ | 학술논문

目的：探讨输尿管镜直视下逆推结石非原位配合钬激光碎石治疗输尿管中下段结石的安全性和有效性。方法60例输尿管中下段结石患者纳入本研究，其中30例采用逆推结石非原位输尿管镜钬激光碎石术（实验手术组），即直视下先将结石逆推至梗阻部位稍上方输尿管扩张处，再于非梗阻原位视野开阔处采用钬激光碎石；30例直视下找到结石后即行原位钬激光碎石术（传统手术组）。比较两组的总手术时间、碎石时间、一次性结石清除率以及手术并发症情况。结果60例患者均全部成功碎石。实验组和传统组的总手术时间分别为（40±6）min 和（55±8）min（t=-5.64，P<0.05），碎石时间分别为（12±5）min 和（20±6）min（t=-9.36，P<0.05），一次结石取净率分别为100.0%（30/30）和96.7%（29/30）。传统手术组中输尿管发生穿孔1例，两组术中均无输尿管断裂、袖状撕脱和尿源性败血症等严重并发症发生。结论对于选择病例，输尿管镜下逆推结石非原位钬激光碎石术处理输尿管中下段结石安全有效，较原位碎石能减少碎石时间及手术并发症。
목적：탐토수뇨관경직시하역추결석비원위배합화격광쇄석치료수뇨관중하단결석적안전성화유효성。방법60례수뇨관중하단결석환자납입본연구，기중30례채용역추결석비원위수뇨관경화격광쇄석술（실험수술조），즉직시하선장결석역추지경조부위초상방수뇨관확장처，재우비경조원위시야개활처채용화격광쇄석；30례직시하조도결석후즉행원위화격광쇄석술（전통수술조）。비교량조적총수술시간、쇄석시간、일차성결석청제솔이급수술병발증정황。결과60례환자균전부성공쇄석。실험조화전통조적총수술시간분별위（40±6）min 화（55±8）min（t=-5.64，P<0.05），쇄석시간분별위（12±5）min 화（20±6）min（t=-9.36，P<0.05），일차결석취정솔분별위100.0%（30/30）화96.7%（29/30）。전통수술조중수뇨관발생천공1례，량조술중균무수뇨관단렬、수상시탈화뇨원성패혈증등엄중병발증발생。결론대우선택병례，수뇨관경하역추결석비원위화격광쇄석술처리수뇨관중하단결석안전유효，교원위쇄석능감소쇄석시간급수술병발증。
Objective To evaluate the reverse pushing method during ureteroscopic holmium laser lithotripsy in the treatment of middle- inferior ureteral stones. Methods 60 patients with middle- lower ureteral stone were randomly selected in this study. Reverse pushing method group: 30 cases, and control group: 30 cases. The operative time, gravel time, full- time stone clearance rate and perioperative complications in these two groups were evaluated. Results All operations were successful with no case transferred to open surgery. Total operation time in study group and control group were (40±6) min vs (55± 8) min (t=-5.64, P<0.05). Time of stone removal were (12±5) min vs (20±6) min(t=-9.36, P<0.05). Stone clearance rate were 100.0% (30/30) vs 96.7% (29/30). One case suffered from ureteral perforation in the control group. No ureter breakage, avulsion or septicemia occurred in two groups. Conclusion For selected cases, ureteroscopic holmium laser lithotripsy with reverse pushing method is one of safe and effective mangement for middle-lower ureteral calculi.