目的 探讨输尿管镜下阻挡网篮配合激光碎石术治疗非复杂性输尿管上段结石的疗效.方法 121例非复杂性输尿管上段结石病例随机分为2组,58例行输尿管镜碎石术(ureteoscopic lithotripsy,URL),其余63例行体外冲击波碎石术(extracorporeal shock wave lithotripsy,ESWL)作为对照.URL组用WOLF硬性输尿管镜,配用自制阻挡网篮连接U-100双频双脉冲激光机后进行碎石,术后留置D-J管,ESWL组采用多尼尔Cigma双定位体外冲击波碎石机进行碎石.结果 URL组和ESWL组的一次碎石成功率分别为93.1%和 93.7%,术后1个月结石清除率分别为 93.1%和90.4%,术后并发症发生率分别为1.7%和1.6%,两组间差异无统计学意义.URL组和ESWL组的治疗时间分别为(15±2.3) min和(33.5±6.4)min,术后1周结石清除率分别为93.1%和69.8%,URL组优于ESWL组,差异有统计学意义.URL组出现1例输尿管穿孔,ESWL组出现1例包膜下血肿.结论 对非复杂性输尿管上段结石的治疗,输尿管镜下阻挡网篮配合激光碎石术可明显缩短治疗时间、加速结石排出,有利于患者及早康复.%Objective To explore the effect of laser lithotripsy combined stone dislodger under ureteroscopy on the treatment of non-complicated upper ureteral calculi. Methods One hundred and twenty-one cases with non-complicated upper ureteral calculi were divided into 2 groups randomly. Fifty-eight cases of URL group received ureteroscopic lithottipsy (URL) by U-100 double-frequency laser lithotripsy combined with self-made stone dislodger under Wolf ureteroscopy and D-J catheter was placed post-operation. Sixty-three cases received extracorporeal shock wave lithotripsy (ESWL) by Dornier Cigma double localization extracorporeal shock-wave lithotripter in comparison. Results In URL and ESWL group,success rate on one session were 93.1％ and 93.7％ ,stone-free rate after one month were 93.1％ and 90.4％ ,and postoperative complication were 1.7 ％ and 1.6％. All of them had no statistical difference between these two groups. In URL and ESWL group, treatment time were (15 ±2.3)min and (33.5 ± 6.4)min,and stone-free rate after one week were 93.1％ and 69.8％.Both of them had statistical differences between these two groups,and URL group had better effect than ESWL. One case of ureter perforation occurred in TUL group,and 1 case of renal capsular hematoma occurred 2n ESWL group.Conclusions Laser lithotripsy combined with stone dislodger under ureteroscopy can shorten the time of treatment and speed up stone discharging in favor of patient recovery.
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