CAJ | 학술논문

目的：探讨输尿管软镜下钬激光碎石治疗体外震波碎石失败后复杂性输尿管结石的临床效果。方法选取2014年2月-2014年12月期间该院收治的复杂性输尿管结石患者80例，其中40例体外震波碎石失败后使用微创经皮肾穿刺取石+术(MPCNL)的患者作为对照组，另外40例体外震波碎石失败后使用输尿管软镜下钬激光碎石治疗的患者作为研究组，分析研究两组的治疗效果。结果对照组患者碎石成功率为95.0%(38/40)，研究组患者中碎石成功率为92.50%(37/40)，上段结石成功率80.00%(8/10)，中段结石成功率90.00%(9/10)，下段结石成功率95.00%(19/20)，失败3例，占7.50%(3/40)，研究组与对照组碎石成功率之间差异无统计学意义(P>0.05)。其中有2例冲入肾盂后再次经输尿管软镜下钬激光碎石治疗，1例通过后腹腔镜下输尿管结石切开取石的方式取石，手术中输尿管穿孔1例，手术平均时间(65±15.50)min，住院时间(7.50±1.50)d。结论输尿管软镜下钬激光碎石是一种治疗体外震波碎石失败后复杂性输尿管结石的可靠手段，临床应用前景广阔。
목적：탐토수뇨관연경하화격광쇄석치료체외진파쇄석실패후복잡성수뇨관결석적림상효과。방법선취2014년2월-2014년12월기간해원수치적복잡성수뇨관결석환자80례，기중40례체외진파쇄석실패후사용미창경피신천자취석+술(MPCNL)적환자작위대조조，령외40례체외진파쇄석실패후사용수뇨관연경하화격광쇄석치료적환자작위연구조，분석연구량조적치료효과。결과대조조환자쇄석성공솔위95.0%(38/40)，연구조환자중쇄석성공솔위92.50%(37/40)，상단결석성공솔80.00%(8/10)，중단결석성공솔90.00%(9/10)，하단결석성공솔95.00%(19/20)，실패3례，점7.50%(3/40)，연구조여대조조쇄석성공솔지간차이무통계학의의(P>0.05)。기중유2례충입신우후재차경수뇨관연경하화격광쇄석치료，1례통과후복강경하수뇨관결석절개취석적방식취석，수술중수뇨관천공1례，수술평균시간(65±15.50)min，주원시간(7.50±1.50)d。결론수뇨관연경하화격광쇄석시일충치료체외진파쇄석실패후복잡성수뇨관결석적가고수단，림상응용전경엄활。
Objective To evaluate the efficacy of the holmium laser lithotripsy under Flexible ureteroscope for the complexity ureteral calculi after failed extracorporeal shock-wave lithotripsy(ESWL). Methods 80 complexity ureteral calculi patients were di-vided into control group and study group during February 2014 to December 2014, 40 patients after failed ESWL treated with MPCNL as control group and 40 after failed ESWL treated with holmium laser lithotripsy under ureteroscope as study group. Com-pared the successful rates and failure rates. Results The success rate in the control group was 95.0%(38/40)and in the study group the overall stone-free rate was 92.50%(37/40), and the successful rate was 80.00%(8/10)in the upper segment, 90.00%(9/10)in the middle segment, 95.00%(19/20)in the lower segment, 7.50%(3/40) failed. The differences of the success rate between the study group and the control group was not statistically significant (P>0.05). 2 of them were failed due to the stones returning to the kidney and treated with ESWL again, 1 of them chose for Retroperitoneoscopic lithotomy. 1 case was encountered ureter perfora-tion. The mean operative time was(65±15.50)mins and the average hospitalization time was(7.50±1.50)days. Conclusion Holmi-um laser lithotripsy under ureteroscope after failed ESWL for ureteral calculi was feasible and effective.