【摘要】：目的：探討逆行輸尿管鏡鈥激光碎石術(shù)對(duì)嵌頓性輸尿管結(jié)石的治療效果,并對(duì)手術(shù)效果的相關(guān)因素進(jìn)行分析。方法：選擇我院128例輸尿管結(jié)石患者,根據(jù)結(jié)石是否嵌頓,分為非嵌頓組70例和嵌頓組58例,比較逆行輸尿管鏡鈥激光碎石術(shù)對(duì)兩組患者的療效、手術(shù)并發(fā)癥情況,并分析兩組手術(shù)失敗的原因和嵌頓組碎石成功率與結(jié)石位置和大小的關(guān)系。結(jié)果：非嵌頓組與嵌頓組的一次性碎石成功率、手術(shù)時(shí)間、術(shù)后肉眼血尿發(fā)生率分別為91.4%(64/70)與74.1%(43/58)、(36.3±10.7)min與(45.2±13.9)mmin、51.4%(36/70)與84.5%(49/58),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。非嵌頓組與嵌頓組術(shù)后住院時(shí)間、止痛藥使用率、尿路感染率、輸尿管穿孔率分別是(1.5±1.2)d與(1.9±1.4)d、1.4%(1/70)與6.9%(4/58)、7.1%(5/70)與12.1%(7/58)、0(0/70)與6.9%(4/58),差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。非嵌頓組中共6例手術(shù)失敗,主要原因是術(shù)中輸尿管結(jié)石上移；嵌頓組15例手術(shù)失敗,主要原因包括結(jié)石殘片上移、輸尿管過(guò)度扭曲、輸尿管狹窄、輸尿管穿孔、結(jié)石大而硬。在嵌頓組中有32例合并有輸尿管壁肉眼的病理變化,其中輸尿管黏膜明顯充血水腫22例,輸尿管壁肉芽或息肉6例,輸尿管狹窄4例。嵌頓組中位于腰4椎體橫突以上的結(jié)石碎石成功率為58.3%,而腰4椎體橫突以下為85.3%,差異有統(tǒng)計(jì)學(xué)意義P0.05)。嵌頓組中在腰4椎體橫突上、下結(jié)石直徑1cm與≤1cm組的碎石成功率分別為63.6%(7/11)、53.8%(7/13)和78.9%(15/19)、93.3%(14/15),差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；嵌頓組中腰4椎體橫突上、下輕中度與重度組腎積水手術(shù)成功率分別為57.1%(8/14)、60%(6/10)和81.3%(13/16)、88.9%(16/18),差異均無(wú)統(tǒng)計(jì)學(xué)意義P0.05)。結(jié)論：嵌頓性輸尿管結(jié)石較非嵌頓性結(jié)石手術(shù)難度大,碎石成功率低,主要影響因素為輸尿管扭曲及結(jié)石碎片上移；嵌頓性輸尿管結(jié)石可合并輸尿管壁充血水腫、炎性肉芽和息肉、輸尿管狹窄；在腰4椎體橫突平面以上,嵌頓性結(jié)石的碎石成功率較該平面以下的低,嵌頓性輸尿管結(jié)石的碎石成功率可能與結(jié)石大小和腎積水程度無(wú)明顯關(guān)系。
[Abstract]:Objective: to investigate the effect of retrograde ureteroscopic holmium: YAG laser lithotripsy on incarcerated ureteral calculi. Methods: 128 patients with ureteral calculi in our hospital were divided into non-incarcerated group (n = 70) and incarcerated group (n = 58) according to whether they were incarcerated. The efficacy and complications of retrograde ureteroscopic holmium laser lithotripsy were compared. The causes of failure and the relationship between the success rate of stone and the location and size of stone in incarcerated group were analyzed. Results: the success rate and operative time of unincarcerated group and incarcerated group were 91.4% (64 / 70) and 74.1% (43 / 58), (36.3 鹵10.7) min and (45.2 鹵13.9) mmin, respectively. 51.4% (36 / 70) and 84.5% (49 / 58), the difference was statistically significant (P0.05). The postoperative hospitalization time, analgesic usage rate, urinary tract infection rate and ureteral perforation rate were 1.4% (1 / 70) and 6.9% (4 / 58) in non-incarcerated and incarcerated groups, respectively. There was no significant difference between 7.1% (5 / 70) and 12. 1% (7 / 58), 0 (0 / 70) and 6.9% (4 / 58) (P0.05). In the non-incarcerated group, 6 cases failed, the main reason was the upward movement of ureteral calculi during the operation, 15 cases in the incarcerated group failed, the main reasons included the upward movement of stone fragments, the excessive distortion of ureter, the stricture of ureter, ureteral perforation, large and hard stone. In the incarcerated group, 32 cases were accompanied with pathological changes of ureteral wall, including 22 cases of hyperemia and edema of ureteral mucosa, 6 cases of granulation or polyp of ureteral wall and 4 cases of ureteral stricture. In the incarcerated group, the success rate of lithotripsy above the transverse process of the lumbar 4 vertebrae was 58.3, while that below the transverse process of the lumbar 4 vertebrae was 85.3, the difference was statistically significant (P0.05). In the incarcerated group, the lithotripsy success rates of 1cm and 鈮，

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