上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

输尿管上段较小结石的输尿管镜治疗分析

潘隽玮1，王祥慧2，徐达1，邵远1，张敏光1，王大伟1，陆国樑1，屠卫超1   

  1. 上海交通大学 医学院 1.附属瑞金医院北院泌尿外科, 上海 201801； 2.附属瑞金医院肾脏移植中心, 上海 200025
  • 出版日期:2015-11-28 发布日期:2016-01-13
  • 通讯作者: 王祥慧, 电子信箱: wxh@medmail.com.cn。
  • 作者简介:潘隽玮（1985—）， 男， 住院医师， 硕士; 电子信箱: pjw_wqsguitar@sina.com。
  • 基金资助:

    上海市科委课题（10DZ2212000）

Analysis of ureteroscopic treatment of small renal stones in upper ureter

PAN Jun-wei1, WANG Xiang-hui2, XU Da1, SHAO Yuan1, ZHANG Min-guang1, WANG Da-wei1, LU Guo-liang1, TU Wei-chao1   

  1. 1.Department of Urological Surgery, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine， Shanghai 201801, China； 2.Kidney Transplantation Center, Ruijin Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200025, China
  • Online:2015-11-28 Published:2016-01-13
  • Supported by:

    Project of Science and Technology Commission of Shanghai Municipality, 10DZ2212000

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摘要：

目的  以输尿管镜治疗下的输尿管上段较小结石（横径≤0.6 cm、顺径≤1.0 cm）为研究对象，分析这些结石横径、顺径、最长径与临床各事件或因素的相互关系，为输尿管上段较小结石临床合理治疗提供依据。方法  搜集输尿管镜治疗的输尿管上段横径≤0.6 cm、顺径≤1.0 cm的较小结石病例共56例，分别以结石横径＜0.5 cm与≥0.5 cm、横径≤0.5 cm与＞0.5 cm、横径≤0.55 cm与＞0.55 cm、结石顺径≤0.6 cm与＞0.6 cm、顺径≤0.5 cm与＞0.5 cm、结石最长径≤0.6 cm与＞0.6 cm、最长径＜0.6 cm与≥0.6 cm以及结石横径-顺径比值≤1与＞1进行分组研究，对比每组在结石既往史、结石病程、结石移位、术前腰部酸痛症状、肾积水程度、合并输尿管狭窄、合并输尿管息肉、合并输尿管狭窄或息肉和输尿管镜治疗成功率等方面的差异，同时研究结石横径与顺径直线线性相关性。结果  结石横径＜0.5 cm（21例）与≥0.5 cm（35例）分组中，两者在病程、合并输尿管狭窄、合并输尿管狭窄或息肉等方面差异有统计学意义(P<0.05或P<0.01)；结石横径≤0.5 cm（31例）与＞0.5 cm（25例）分组中，两者仅在合并输尿管狭窄方面差异有统计学意义(P<0.05)；结石顺径≤0.5 cm（24例）与＞0.5 cm（32例）、最长径＜0.6 cm（23例）与≥0.6 cm（33例）分组仅在病程方面差异具有统计学意义(P<0.05)；而结石横径≤0.55 cm（42例）与>0.55 cm（14例）、结石顺径≤0.6 cm（37例）与＞0.6 cm（19例）、结石最长径≤0.6 cm（36例）与＞0.6 cm（20例）以及结石顺径-横径比值≤1（31例）与＞1（25例）等分组中，各项指标差异均无统计学意义(P>0.05)；结石横径＜0.5 cm组病程≤10 d且无结石移位者比例明显高于结石横径≥0.5 cm组（P<0.05）；并且均合并输尿管狭窄或息肉，结石横径与顺径成直线线性相关。结论  结石横径，而非顺径或最长径，可作为输尿管上段较小结石简化测量指标，并在其相关治疗中具有重要临床意义。对于横径＜0.5 cm的输尿管上段结石，非结石体积相关的机械梗阻因素占主导，短期内（10 d）不移位即可作为非药物治疗的干预指征，而输尿管镜治疗具有重要检查与治疗意义。

关键词: 输尿管上段结石, 输尿管镜, 横径, 顺径, 最长径

Abstract:

Objective  To analyze correlationship between transverse diameter, longitudinal diameter, and the longest diameter of small upper ureteral stones (transverse diameter ≤0.6 cm and longitudinal diameter ≤1.0 cm) and clinical events or factors and provide evidences for the treatment of patients with small upper ureteral stones. Methods  A total of 56 patients with small upper ureteral stones (transverse diameter ≤0.6 cm and longitudinal diameter ≤1.0 cm) who were treated by ureteroscope were selected. Patients were divided into groups according to transverse diameter ＜0.5 cm and ≥0.5 cm, transverse diameter ≤0.5 cm and ＞0.5 cm, transverse diameter ≤0.55 cm and ＞0.55 cm, longitudinal diameter ≤0.6 cm and ＞0.6 cm, longitudinal diameter ≤0.5 cm, and ＞0.5 cm, the longest diameter ≤0.6 cm and >0.6 cm, the longest diameter <0.6 cm and ≥0.6 cm, and ratio of transverse diameter and longitudinal diameter ≤1 and ＞1. The differences of stone history, course of disease, displacement, symptom of pre-operative waist pain, degree of hydronephrosis, combined ureteral ureterostenosis, combined ureteral polyp, combined ureteral ureterostenosis or polyp, and success rate of ureteroscopic treatment of groups were compared and the linear correlation between transverse diameter and longitudinal diameter was studied. Results  For the transverse diameter ＜0.5 cm group (n=21) and transverse diameter ≥0.5 cm group (n=35), the differences of course of disease, combined ureteral ureterostenosis, and combined ureteral ureterostenosis or polyp were statistically significant (P<0.05 or P<0.01). For the transverse diameter ≤0.5 cm group (n=31) and transverse diameter >0.5 cm group (n=25), only the difference of combined ureteral ureterostenosis was statistically significant (P<0.05). For the transverse diameter ≤0.5 cm group (n=24) and transverse diameter >0.5 cm group (n=32), and the longest diameter ＜0.6 cm group (n=23) and the longest diameter ≥0.6 cm group (n=33), only the difference of course of disease was statistically significant (P<0.05). For the transverse diameter ≤0.55 cm group (n=42) and transverse diameter ＞0.55 cm group (n=14), longitudinal diameter ≤0.6 cm group (n=37) and longitudinal diameter ＞0.6 cm group (n=19), the longest diameter ≤0.6 cm group (n=36) and the longest diameter ＞0.6 cm group (n=20), and ratio of transverse diameter and longitudinal diameter ≤1 group (n=31) and ratio of transverse diameter and longitudinal diameter＞1 group (n=25), the differences of all items were not statistically significant (P>0.05). The rate of patients with no stone displacement and the course of disease ≤10 d of the transverse diameter ＜0.5 cm group was higher than that of the transverse diameter ≥0.5 cm group (P＜0.05), and patients were all combined with ureteral ureterostenosis or polyp and the transverse diameter linearly correlated with the longitudinal diameter. Conclusion  The transverse diameter, rather than longitudinal diameter or the longest diameter, is the simplified measure index with important clinical significance for the treatment of small upper ureteral stones. For upper ureteral stones with transverse diameters ＜0.5 cm, the main factor is mechanical obstruction that is irrelevant to the stone volume and no stone displacement in a short period of time (10 d) can be considered as one of intervention indications. Ureteroscope is important for examination and treatment.

Key words: upper ureteral stone, ureteroscope, transverse diameter, longitudinal diameter, the longest diameter