主动迁移技术与原位碎石技术在输尿管软镜治疗1~2 cm输尿管上段结石中的安全性和有效性比较

doi:10.19723/j.issn.1671-167X.2023.03.024

摘要/Abstract

摘要：

目的: 比较在逆行输尿管软镜治疗1~2 cm输尿管上段结石过程中应用主动迁移技术与原位碎石技术的安全性和有效性。方法: 选取2018年8月至2020年8月北京友谊医院泌尿科收治的1~2 cm输尿管上段结石患者为研究对象，共90例。采用随机数字表法将患者分为原位碎石技术组(A组)45例和主动迁移技术组(B组)45例。所谓主动迁移技术是通过体位变化、水流冲刷、激光冲击或网篮移位等手段的辅助，将结石重新放置于便于碎石的肾盏内，再进行激光碎石和取石。收集患者术前、术中和术后的数据，进行统计分析。结果: A组患者年龄(51.6±14.1)岁，其中男性34例、女性11例；结石直径为(1.48±0.24) cm，结石密度(897.8±175.9) Hu；结石位于左侧26例、右侧19例；肾积水程度：无肾积水8例，Ⅰ度肾积水20例，Ⅱ度肾积水11例，Ⅲ度肾积水6例。B组患者年龄(51.8±13.7)岁，其中男性30例、女性15例；结石直径(1.52±0.22) cm，结石密度(964.6±214.2) Hu；结石位于左侧22例、右侧23例；肾积水程度：无肾积水10例，Ⅰ度肾积水23例，Ⅱ度肾积水8例，Ⅲ度肾积水4例。两组患者的一般参数和结石指标差异均无统计学意义。A组和B组患者手术时间分别为(67.1±16.9) min和(72.2±14.8) min，碎石时间分别为(38.0±13.2) min和(40.6±12.6) min，两组间差异均无统计学意义。术后4周A组和B组清石率分别为86.7%和97.8%，差异亦无统计学意义。并发症方面，A组出现血尿25例、疼痛16例、膀胱痉挛10例、轻度发热4例，B组出现血尿22例、疼痛13例、膀胱痉挛12例、轻度发热2例，两组差异无统计学意义。结论: 应用主动迁移技术治疗1~2 cm的输尿管上段结石具有良好的安全性和有效性。

关键词: 输尿管结石, 输尿管软镜, 碎石术, 主动迁移技术, 治疗结果

Abstract:

Objective: To compare the safety and effectiveness of active migration technique and in situ lithotripsy technique in the treatment of 1-2 cm upper ureteral calculi by retrograde flexible ureteroscopy. Methods: A total of 90 patients with 1-2 cm upper ureteral calculi treated in the urology department of Beijing Friendship Hospital from August 2018 to August 2020 were selected as the subjects. The patients were divided into two groups using random number table: 45 patients in group A were treated with in situ lithotripsy and 45 patients in group B were treated with active migration technique. The active migration technique was to reposition the stones in the renal calyces convenient for lithotripsy with the help of body position change, water flow scouring, laser impact or basket displacement, and then conduct laser lithotripsy and stone extraction. The data of the patients before and after operation were collected and statistically analyzed. Results: The age of the patients in group A was (51.6±14.1) years, including 34 males and 11 females. The stone diameter was (1.48±0.24) cm, and the stone density was (897.8±175.9) Hu. The stones were located on the left in 26 cases and on the right in 19 cases. There were 8 cases with no hydronephrosis, 20 cases with grade Ⅰ hydronephrosis, 11 cases with grade Ⅱ hydronephrosis, and 6 cases with grade Ⅲ hydronephrosis. The age of the patients in group B was (51.8±13.7) years, including 30 males and 15 females. The stone diameter was (1.52±0.22) cm, and the stone density was (964.6±214.2) Hu. The stones were located on the left in 22 cases and on the right in 23 cases. There were 10 cases with no hydronephrosis, 23 cases with grade Ⅰ hydronephrosis, 8 cases with grade Ⅱ hydronephrosis, and 4 cases with grade Ⅲ hydronephrosis. There was no significant diffe-rence in general parameters and stone indexes between the two groups. The operation time of group A was (67.1±16.9) min and the lithotripsy time was (38.0±13.2) min. The operation time of group B was (72.2±14.8) min and the lithotripsy time was (40.6±12.6) min. There was no significant difference between the two groups. Four weeks after operation, the stone-free rate in group A was 86.7%, and in group B was 97.8%. There was no significant difference between the two groups. In terms of complications, 25 cases of hematuria, 16 cases of pain, 10 cases of bladder spasm and 4 cases of mild fever occurred in group A. There were 22 cases of hematuria, 13 cases of pain, 12 cases of bladder spasm and 2 cases of mild fever in group B. There was no significant difference between the two groups. Conclusion: Active migration technique is safe and effective in the treatment of 1-2 cm upper ureteral calculi.

Key words: Ureteral calculi, Flexible ureteroscopy, Lithotripsy, Active migration technique, Treatment outcome

中图分类号:

R693.4

王磊,韩天栋,江卫星,李钧,张道新,田野. 主动迁移技术与原位碎石技术在输尿管软镜治疗1~2 cm输尿管上段结石中的安全性和有效性比较[J]. 北京大学学报（医学版）, 2023, 55(3): 553-557.

Lei WANG,Tian-dong HAN,Wei-xing JIANG,Jun LI,Dao-xin ZHANG,Ye TIAN. Comparison of safety and effectiveness of active migration technique and in situ lithotripsy technique in the treatment of 1-2 cm upper ureteral calculi by flexible ure-teroscopy[J]. Journal of Peking University (Health Sciences), 2023, 55(3): 553-557.

图/表 2

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参考文献 11

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4	Abedi G , Monga M . Flexible ureteroscopy for treatment of upper urinary tract calculus[J]. J Endourol, 2021, 35 (S2): S56- S61. doi: 10.1089/end.2020.1018
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6	Wu WS , Zhang JQ , Yi RXT , et al. Cost-effectiveness of anti-retropulsive devices varies according to the locations of proximal ureteral stones: A retrospective cohort study[J]. BMC Urol, 2022, 22 (1): 43. doi: 10.1186/s12894-022-00995-9
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8	Pan JH , Xue W , Xia L , et al. Ureteroscopic lithotripsy in trendelenburg position for proximal ureteral calculi: A prospective, randomized, comparative study[J]. Int Urol Nephrol, 2014, 46 (10): 1895- 1901. doi: 10.1007/s11255-014-0732-z
9	Jung W , Byun HJ , Lee DS . The role of antegrade irrigation via percutaneous nephrostomy on surgical outcomes in semirigid ure-teroscopy among patients with upper ureteral stones[J]. Biomed Res Int, 2019, 2019, 8657609.
10	Elgebaly O , Abdeldayem H , Idris F , et al. Antegrade mini-percutaneous flexible ureteroscopy versus retrograde ureteroscopy for treating impacted proximal ureteric stones of 1-2 cm: A prospective randomised study[J]. Arab J Urol, 2020, 18 (3): 176- 180. doi: 10.1080/2090598X.2020.1769385
11	Chen YC , Chen HW , Juan YS , et al. Management of large proximal ureteral calculi: A three-year multicenter experience of simultaneous supine percutaneous nephrolithotomy and retrograde ure-terolithotripsy[J]. Urol J, 2019, 16 (5): 433- 438.

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Variable	Group A (n=45)	Group B (n=45)	P
Age/years, ${\bar x}$±s	51.6±14.1	51.8±13.7	0.975
Gender, n(%)			0.865
Male	34 (75.6)	30 (66.7)
Female	11 (24.4)	15 (33.3)
Stone criteria, ${\bar x}$±s
Size/cm	1.48±0.24	1.52±0.22	0.489
Density/Hu	897.8±175.9	964.6±214.2	0.092
Laterality, n(%)			0.714
Left	26 (57.8)	22 (48.9)
Right	19 (42.2)	23 (51.1)
Hydronephrosis, n(%)			0.290
No	8 (17.8)	10 (22.2)
Grade Ⅰ	20 (44.4)	23 (51.1)
Grade Ⅱ	11 (24.4)	8 (17.8)
Grade Ⅲ	6 (13.3)	4 (8.9)

Variable	Group A	Group B	P
Operative time/min, ${\bar x}$±s	67.1±16.9	72.2±14.8	0.633
Lithotripsy time/min, ${\bar x}$±s	38.0±13.2	40.6±12.6	0.757
Residual stone, n(%)			0.110
No	39 (86.7)	44 (97.8)
Yes	6 (13.3)	1 (2.2)
Complications, n(%)
Haematuria	25 (55.6)	22 (48.9)	0.527
Pain (mild to moderate)	16 (35.6)	13 (28.9)	0.499
Bladder irritative symptoms	10 (22.2)	12 (26.7)	0.624
Low-grade fever	4 (8.9)	2 (4.4)	0.677