| Objective:With the improvement of living standard and the change of eating habits,the incidence of urinary calculi is higher and higher,of which,ureteral stones are the most common.The treatment of ureteral stones including conservative treatment,extracorporeal shock wave lithotripsy,ureteroscopy lithotripsy,percutaneous nephroscope lithotripsy,laparoscope ureter incision to take stone surgery and traditional open surgery.At present,the common methods of ureteroscopy include holmium laser lithotripsy and pneumatic lithotripsy.Because of the different principles of the two kinds of lithotripsy,there may be differences in the efficacy and safety of the treatment of ureteral stones.This study compared clinical data on these two types of surgical method and the efficacy and safety of these two methods in the treatment of ureteral calculi were analyzed by statistical method.The clinical experience of ureteroscopic holmium laser lithotripsy was also discussed,which provided reference for clinical practice.Methods:The clinical data of two kinds of surgical procedures(246 cases of ureteroscopic holmium laser lithotripsy and ureteroscopic pneumatic lithotripsy in 215 cases)were compared from September 2014 to September 2016 in our hospital.According to the successful rate of lithotripsy,stone of intraoperative escape rate,treatment of intraoperative complications(polyps and stenosis),operation time,length of hospital stays,and complications(intraoperative ureteral perforation,urinary extravasation,intraoperative ureteral mucosa avulsion,intraoperative ureteral rupture,postoperative fever,postoperative hematuria),stone clearance rate of data,statistical analysis was done to compare the advantages and disadvantages of the two kinds of surgical methods.Result:For the upper ureteral stones,the successful rate of lithotripsy,stone clearance rate and stone of intraoperative escape rate in surgery of HL group were 88.37%,83.72%,11.63% respectively,is better than that of group PL 67.57%,62.16%,32.43%,the difference was statistically significant(P < 0.05).For the middle ureteral stones,the successful rate of lithotripsy,stone clearance rate and stone of intraoperative escape rate in operation of HL group were 92.96%,88.73%,7.04% respectively,PL group was 89.83%,83.05% and 10.17% respectively,and for the lower ureteral stones,the successful rate of lithotripsy,stone clearance rate and stone of intraoperative escape rate in operation of HL group were 97.73%,94.70%,2.27% respectively,PL group was 97.48%,91.60% and 2.52% respectively.For the middle and lower ureteral stones,there was no significant difference between the two groups in terms of the above.Group HL operation time,length of hospital stay,postoperative hematuria was 39.0286±13.0561 min,6.2857±1.9034 d,1.7290±0.8888 d respectively,significantly shorter than PL group was 47.9742±18.1749 min,6.7804±2.3384 d,2.0327 ±0.7005 d,the difference was statistically significant(P < 0.5).Neither group had serious intraoperative and postoperative complications.But,the holmium laser has the advantage of burning or cutting the polyp or stenosis and then treating the stones.Conclusion:Ureteroscopy holmium laser lithotripsy and pneumatic lithotripsy in the treatment of ureteral stones were safe,effective and less trauma,quick recovery,less intraoperative and postoperative complication etc.For the upper ureteral stones,the holmium laser group has higher successful rate of lithotripsy,stone clearance rate and lower stone of intraoperative escape rate.The holmium laser group was superior to pneumatic group in terms of postoperative hematuria,operation time,and length of hospital stay.The holmium laser can also handle ureteral polyps and stenosis during operation.Ureteroscopy holmium laser lithotripsy is especially applicable to ureteral stones in the upper segment,especially those with polyps and stenosis ureteral stones.It is the ideal surgical method for treating ureteral stones. |
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