Comparison of the Efficacy of ShuoTong Ureteroscopy and Simple Flexible Ureteroscopy in the Treatment of Unilateral Upper Ureteral Calculi.
Comparison of the Efficacy of ShuoTong Ureteroscopy and Simple Flexible Ureteroscopy in the Treatment of Unilateral Upper Ureteral Calculi.
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DOI：
10.3389/fsurg.2021.707022
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发表时间：
2021
影响因子：
1.8
通讯作者：
Chen B
中科院分区：
文献类型：
--
作者：
Lai L;Zhang W;Zheng F;Wang T;Bai P;Liu Z;Zheng J;Shao Z;Duan B;Wang H;Xing J;Chen H;Huang Y;Chen B
背景资料：硕通输尿管镜术（ShuoTong ureteroscopy，ST-URS）是在输尿管镜术的基础上发展起来的一种新的碎石术式，在国内广泛应用于输尿管结石的治疗。其组成包括硬质输尿管通路鞘、标准镜、碎石镜、硕通灌注吸引器（ST-APM）。在此，我们比较了ST-URS和输尿管软镜（F-URS）钬激光碎石术治疗单侧输尿管上段结石的有效性和安全性。研究方法：回顾性分析了280例符合纳入标准的患者的临床资料：1）尿路CT诊断为L4腰椎以上单侧输尿管上段单发结石; 2）患者年龄在18 - 80岁之间; 3）患者知情并同意参加本研究; 4）患者经医院伦理委员会批准（证明编号：KY-2019-020）和排除标准，于2018年1月至2020年11月在厦门大学附属第一医院行单侧输尿管上段结石，分为ST-URS组和输尿管软镜（F-URS）组。结果如下：ST-URS组术后1天的结石清除率明显高于F-URS组（63.71%比34.62%，P < 0.0001）。ST-URS组的手术时间（38.45 vs. 46.18 min，P = 0.005）和住院费用（27,203 vs. 33,220元，P < 0.0001）明显低于F-URS组。两组患者输尿管镜置管成功率、术中出血量、术后1个月结石排净率、术后并发症、术后住院时间、术后视觉模拟评分（VAS）疼痛评分差异均无统计学意义（P > 0.05）。在结石直径≥ 1.5 cm、结石CT值≥ 1,000 Hounsfield单位、术前肾积水范围≥ 3.0 cm的亚组中，ST-URS在手术时间、术后1 d结石排净率、住院费用、术后并发症发生率等方面具有优势。结论：钬激光治疗单侧输尿管上段结石，ST-URS较单纯F-URS手术时间短，住院费用低，术后1 d结石排净率高，值得临床推广应用。
Background: ShuoTong ureteroscopy (Sotn-ureteroscopy, ST-URS), a new lithotripsy operation method developed on the basis of ureteroscopy, is widely used to treat ureteral stones in China. Its composition includes rigid ureteral access sheath, standard mirror, lithotripsy mirror, and ShuoTong perfusion aspirator (ST-APM). Here, we compared the efficacy and safety of the ST-URS and the flexible ureteroscope (F-URS) holmium laser lithotripsy in the treatment of unilateral upper ureteral calculi. Methods: Retrospective analysis was conducted on the clinical data of 280 patients who met the inclusion 1) urinary tract CT was diagnosed with unilateral single upper ureteral calculi above the L4 lumbar spine; 2) patient age was from 18 to 80 years old; 3) patients were informed and consented to this study; and 4) patients were approved by the hospital ethics committee (proof number: KY-2019-020) and the exclusion criteria for unilateral upper ureteral calculi in the First Affiliated Hospital of Xiamen University from January 2018 to November 2020, and they were divided into the ST-URS group and the flexible ureteroscopy (F-URS) group. Results: The stone-free rate of 1 day after operation of the ST-URS group was significantly higher than the F-URS group (63.71 vs. 34.62%, P < 0.0001). The operative time (38.45 vs. 46.18 min, P = 0.005) and hospitalization cost (27,203 vs. 33,220 Yuan, P < 0.0001) of the ST-URS group were significantly lower than the F-URS group. There were no significant differences in the success rate of ureteral access sheath placement, operative blood loss, stone-free rate of 1 month after operation, postoperative complications, postoperative hospital stay, and postoperative visual analog scale (VAS) pain score between the two groups (P > 0.05). In subgroups of a diameter of calculi ≥ 1.5 cm, calculi CT numerical value ≥ 1,000 Hounsfield unit and the preoperative hydronephrosis range ≥ 3.0 cm, ST-URS shows more advantages in the operative time, stone-free rate of 1 day after the operation, the hospitalization cost, and the incidence of postoperative complications. Conclusion: In unilateral upper ureteral stones treated with a holmium laser, compared with the simple F-URS, the ST-URS has a shorter operative time, lower hospitalization cost, and a higher stone-free rate of 1 day after the operation, suggesting that the ST-URS could be more widely applied in clinics.
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