Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China.
J Endourol. 2010 Nov;24(11):1753-7. doi: 10.1089/end.2009.0611. Epub 2010 Sep 19.
To review our 5-year experience with retrograde ureteroscopic treatment for patients with upper ureteral stones and to compare the outcome, safety, and efficiency of pneumatic and holmium laser lithotripsy in managing upper ureteral stones.
We retrospectively analyzed the hospital records of 372 patients who underwent 384 retrograde ureteroscopic procedures for upper ureteral stones at our center from January 2003 to December 2007. Patient and stone characteristics, treatment variables. and clinical outcomes were assessed. Factors such as failure of the procedure, stone clearance, intraoperative and postoperative morbidity, procedure duration, and hospital stay were analyzed and compared between pneumatic (group 1) and laser lithotripsy (group 2).
Overall, the stone-free rate was 90.4%, the mean operative duration was 41.2 ± 10.7 minutes, the mean postoperative hospital stay was 2.7 ± 0.9 days, and the rates of intraoperative and postoperative complications were 14.6% and 3.9%, respectively, for groups 1 and 2. In comparing group 1 and group 2, the significantly higher number of intraoperative complications coincide with a significantly lower stone-free rate. Nevertheless, the incidence of intraoperative and postoperative complications between the two groups was not statistically significant except in the case of stone upward migration. The mean operative time of group 2 was 43.3 ± 11.1 minutes, which was significantly longer than that for group 1, which was 38.7 ± 9.1 minutes (P < 0.05).
Retrograde ureteroscopy is a safe and effective method for managing upper ureteral stones. A high postoperative stone-free rate is associated with the refined use of a holmium laser lithotriptor to ensure thoroughness while avoiding migration of the stones into the renal pelvis. Although laser lithotripsy has a longer operative time, it remains the more appropriate choice for managing upper ureteral stones.
回顾我们在过去 5 年中采用逆行输尿管镜治疗输尿管上段结石的经验，并比较气压弹道碎石术与钬激光碎石术治疗输尿管上段结石的效果、安全性和效率。
我们回顾性分析了 2003 年 1 月至 2007 年 12 月期间在我院接受逆行输尿管镜治疗的 372 例输尿管上段结石患者的病历资料。评估了患者和结石特征、治疗变量和临床结果。分析和比较了气压弹道碎石术（1 组）和激光碎石术（2 组）之间的手术失败率、结石清除率、术中及术后并发症发生率、手术时间和住院时间等因素。
总体而言，结石清除率为 90.4%，手术时间为 41.2±10.7 分钟，术后住院时间为 2.7±0.9 天，术中及术后并发症发生率分别为 14.6%和 3.9%，1 组和 2 组。比较 1 组和 2 组，术中并发症发生率较高，结石清除率较低，但两组间术中及术后并发症发生率无统计学差异，除结石上移外。2 组的手术时间为 43.3±11.1 分钟，明显长于 1 组的 38.7±9.1 分钟（P<0.05）。
逆行输尿管镜是治疗输尿管上段结石的安全有效方法。术后结石清除率高与钬激光碎石器的精细使用有关，可确保彻底碎石，同时避免结石移行至肾盂。虽然激光碎石术的手术时间较长，但仍是治疗输尿管上段结石的更合适选择。
