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目的:本研究旨在比较输尿管镜钬激光碎石术或气压弹道碎石术合并体外冲击波碎石术(ESWL)与单一使用ESWL两种方法处理较大肾盂结石(2～3cm)的手术效果和并发症。方法:治疗肾盂结石为2～3 cm的总共12例患者。被随机分为两组,其中1组为18例,2组为24例。对1组患者首先行钬激光或气压弹道碎石治疗,并于术后置双J管,于2～4周后行ESWL。2组患者,置双J管后行ESWL。3个月后评估两组间结石清除率、并发症和总治疗费用。结果:1组患者中,6例患者(33.3%)行输尿管镜碎石术后,结石被完全击碎,无需继续ESWL处理;7例患者(38.8%)输尿管镜碎石术后需一期ESWL,2例患者(12.5%)术后需二期ESWL,结石才能被完全清除。2组患者一期ESWL成功处理结石为5例(20.8%),二期ESWL成功处理结石为7例(29.1%)。两组结石清除率,1组明显高于2组(83.3%与50.0%,P<0.05)。1组输尿管镜手术时间平均为27 min,2组输尿管镜置输尿管导管平均用时15 min。两组间均未出现严重并发症。两组平均治疗费用分别为3200元和2800元。结论:输尿管镜碎石术联合ESWL治疗肾盂较大结石是一种合理而且有效的治疗方法。
OBJECTIVE: This study aimed to compare the surgical outcomes of ureteroscopic holmium laser lithotripsy or pneumatic lithotripsy with extracorporeal shock wave lithotripsy (ESWL) and single-use ESWL in the treatment of larger pelvis (2-3 cm) and complication. METHODS: A total of 12 patients were treated for pelvic stones of 2 to 3 cm. Were randomly divided into two groups, including a group of 18 cases, two groups of 24 cases. A group of patients first holmium laser or pneumatic lithotripsy treatment, and double J tube in the postoperative, 2 to 4 weeks ESWL. Two groups of patients, double J tube ESWL. Three months later, stone clearance, complications, and total cost of treatment were assessed. RESULTS: Six patients (33.3%) in group 1 underwent ureteroscopic lithotripsy, and the stone was completely crushed without further ESWL treatment. ESWL was required in 7 patients (38.8%) after ureteroscopic lithotripsy , 2 patients (12.5%) required two ESWL after surgery, stones can be completely removed. Two groups of patients with ESWL stones successfully treated in 5 cases (20.8%), two ESWL stones successfully treated in 7 cases (29.1%). The stone clearance rate in both groups was significantly higher in group 1 than in group 2 (83.3% vs 50.0%, P <0.05). The average duration of ureteroscopy operation in group 1 was 27 min, while that in group 2 ureter was 15 min on average. No serious complications occurred between the two groups. The average cost of treatment for the two groups was 3,200 yuan and 2,800 yuan respectively. Conclusion: Ureteroscopic lithotripsy combined with ESWL in the treatment of larger renal pelvis is a reasonable and effective treatment.