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目的:对比单独使用钬激光与配合钬激光使用N-Trap网篮在输尿管镜碎石术治疗输尿管上段术后复发结石中的临床疗效。方法:回顾性分析输尿管上段结石术后复发患者共152例,既往曾采用5种不同方法治疗,其中130例有1~3次ESWL史,7例既往有输尿管镜下气压弹道碎石史,6例既往有PCNL取石史,5例既往有后腹腔镜下输尿管上段切开取石史,4例既往有输尿管上段切开取石史。其中男87例,女65例,结石位于左侧71例,右侧81例。结石长径0.8~2.1cm,结石合并炎性息肉117例,伴输尿管腔明显狭窄9例,结石嵌顿23例。设对照组80例,观察组72例,均采用输尿管镜下钬激光碎石法治疗,其中对照组在术中单独使用钬激光碎石,观察组术中配合钬激光使用N-Trap网篮。比较对照组和观察组术中结石上移率、手术成功率,术后4周结石排净率及并发症情况。结果:术中对照组和观察组结石上移率分别为27.50%(22/80)和2.78%(2/72),碎石成功率分别为71.25%(57/80)和95.83%(69/72),手术成功的两组术后4周结石排净率分别为84.21%(48/57)和97.10%(67/69),两组术中结石上移率、碎石成功率和术后结石排净率相比较差异有统计学意义(P<0.05)。两组术中、术后相关并发症的发生率比较差异无统计学意义(P>0.05)。结论:对于术后复发性输尿管上段结石的输尿管镜下治疗,使用N-Trap拦截网篮联合钬激光碎石,可以显著降低结石上移率,提高碎石和排石成功率,而且可同期处理结石合并炎性息肉和狭窄,是一种比较理想的腔内碎石技术。
OBJECTIVE: To compare the clinical efficacy of ureteroscopic lithotripsy with holmium laser and holmium laser with N-Trap basket in the treatment of recurrent calculus after upper ureteral surgery. Methods: A total of 152 patients with recurrent ureteral calculi were retrospectively analyzed. Among them, there were 5 different treatments in the past, of which 130 had ESWL history of 1 ~ 3 times, 7 had history of ureteroscopic pneumatic lithotripsy, 6 Cases of past history of PCNL stone, 5 cases of retroperitoneoscopic laparoscopic retroperitoneoscopic lithotomy history, 4 cases of previous history of ureteral incision open stone. There were 87 males and 65 females, with 71 cases of stones on the left and 81 cases on the right. Long diameter stones 0.8 ~ 2.1cm, stones with inflammatory polyps in 117 cases, with stenosis of the ureteral cavity in 9 cases, 23 cases of stone incarceration. The control group of 80 cases, the observation group of 72 cases were treated by ureteroscopic holmium laser lithotripsy, the control group in the surgery alone holmium laser lithotripsy, the observation group with holmium laser with N-Trap basket. The control group and observation group intraoperative stone movement rate, the success rate of surgery, 4 weeks after the stone removal rate and complications. Results: The upturn rates of stones in the control group and observation group were 27.50% (22/80) and 2.78% (2/72), respectively. The successful rates of lithotripsy were 71.25% (57/80) and 95.83% (69 / 72). The successful rates of stone removal in four surgeries were 84.21% (48/57) and 97.10% (67/69) respectively in the two groups. The rates of upward movement of stone, the success rate of gravel, The rate of stone discharge was significantly different (P <0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P> 0.05). CONCLUSIONS: Ureteroscopic treatment of recurrent ureteral calculi with N-Trap mesh combined with holmium laser lithotripsy can significantly reduce the rate of stone metastasis, improve the success rate of gravel and stone row, and can be treated simultaneously Stone with inflammatory polyps and stenosis, is an ideal technique of intracavity lithotripsy.