输尿管硬镜碎石术和软镜碎石术术后尿道狭窄临床研究.docVIP

输尿管硬镜碎石术和软镜碎石术术后尿道狭窄临床研究 　　【摘要】 目的：输尿管结石患者分别采用输尿管硬镜碎石术与软镜碎石术治疗，评价术后尿道狭窄发生及治疗情况。方法：256例输尿管结石患者，按照随机数字表法分为两组，分别采用输尿管硬镜碎石术（A组）148例和软镜碎石术（B组）108例手术，中位随访时间为36个月。结果：两组患者术后尿道狭窄发生率（A组25例，B组8例），A组显著高于B组（P0.05），且A组患者尿道狭窄段更长（P0.05）。患者采用了尿道扩张或内镜下冷刀切开手术治疗，手术效果良好，而B组患者最大尿流率改善更加显著（P0.05）。结论：两种手术方式在术后尿道狭窄发生率方面，输尿管软镜组患者发生率更低，且在改善尿道狭窄病情及获得良好疗效方面更具优势。 　　【关键词】 输尿管结石； 尿道狭窄； 输尿管硬镜碎石术； 输尿管软镜碎石术 　　中图分类号 R693 文献标识码 A 文章编号 1674-6805（2015）34-0012-04 　　【Abstract】 Objective：To assess the postoperative urethral stricture between ureteroscopy lithotripsy and flexible ureteroscopy lithotripsy for ureteral calculi.Method：256 cases of ureteral calculi were randomly divided into two groups.148 cases underwent ureteroscopy lithotripsy（A group），and 108 cases underwent flexible ureteroscopy lithotripsy（B group）.They were followed up（median follow-up=36 months）.Result：25 cases occurred urethral stricture in A group，and 8 cases occurred urethral stricture in B group，A group was significantly higher than that of B group（P0.05）.And the length of urethral stricture were significantly extended in A group compared with B group（P0.05）.The patients underwent urethral dilatation or internal urethrotomy， and the effect were satisfactory，the maximum urine flow rate were significantly better in B group（P0.05）.Conclusion：In the aspect of postoperative urethral stricture，A group was significantly higher than that of B group.It has a better effect in improving the condition of urethral stricture and obtaining good treatment effect. 　　【Key words】 Ureteral calculi； Urethral stricture； Ureteroscopy lithotripsy； Flexible ureteroscopy lithotripsy 　　First-author’s address：The Second Hospital of Tianjin Medical University，Tianjin Institute of Urology，Tianjin 300211，China 　　doi：10.14033/j.cnki.cfmr.2015.34.004 　　近年来，由于生活习惯改变、饮食结构西化等因素，我国输尿管结石的发病率显著增加，成为世界上结石高发区之一。原发于输尿管的结石并不多见，通常来源于肾结石，故输尿管结石形成原因与结石成份等均与肾结石相似。多项研究发现，输尿管结石临床多见于青壮年，20～40岁发病率最高，男性显著多于女性。输尿管结石可导致其近端输尿管梗阻、扩张，进一步引起肾积水，出现疼痛、血尿等症状，并危及肾脏，损害肾功能。 　　输尿管结石治疗方法包括体