抗反流装置的成本效益因近端输尿管结石的位置而异：一项回顾性队列研究。
Cost-effectiveness of anti-retropulsive devices varies according to the locations of proximal ureteral stones: a retrospective cohort study.
机构信息
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
BMC Urol. 2022 Mar 24;22(1):43. doi: 10.1186/s12894-022-00995-9.
BACKGROUND
Anti-retropulsive devices are often used to prevent stone migration in the treatment of proximal ureteral calculi. They are helpful. However, in the meantime, they also add extra expenses. This study was carried out to investigate the best criteria for treating proximal ureteral stones with anti-retropulsive devices.
METHODS
Data from all patients who underwent ureteroscopic holmium: YAG laser lithotripsy for solitary upper ureteral stones in 2018 were collected. Patients who encountered stone retropulsion during the process of inserting the ureteroscope were excluded. Patients were divided into either group URS or group URS + ARD depending on whether the anti-retropulsive device was used. Then, the stone-free rate, expenses and other criteria were compared between groups according to stone location. Stone-free was defined as no stones present.
RESULTS
For stones located ≤ 30 mm from the ureteropelvic junction (UPJ), the stone-free rates for the URS group were 80% and 80% at one day and one month after the operation, respectively. Those for the URS + ARD group were 71.4% and 78.6% at one day and one month, respectively. For stones located 31-90 mm from the UPJ, the stone-free rates were 84.7% and 84.7% for the URS group and 89.6% and 95.5% for the URS + ARD group at one day and one month, respectively. A statistically significant difference occurred at one month. For stones located > 90 mm from the UPJ, the two groups were both stone free. In the URS + ARD group, expenses were higher. In addition, the mean diameter of residual stones derived from stones located at 31-90 mm from the UPJ was statistically smaller, and 4 of 7 residual stones passed spontaneously within one month, which was obviously more than that in other locations and the URS group. Other outcomes, including operation time and postoperative stay, showed no significant difference between the groups.
CONCLUSION
Anti-retropulsive devices are indeed helpful, but they might be cost-effective for stones located solely in the middle part of the upper ureter, not for those too close to or far from the ureteropelvic junction.
背景
逆行排斥装置常用于预防近端输尿管结石治疗过程中的结石迁移，这是有帮助的。然而，与此同时，它们也增加了额外的费用。本研究旨在探讨使用逆行排斥装置治疗近端输尿管结石的最佳标准。
方法
收集 2018 年所有接受输尿管镜钬激光碎石术治疗孤立性上段输尿管结石患者的数据。排除在插入输尿管镜过程中遇到结石逆行的患者。根据是否使用逆行排斥装置，将患者分为 URS 组或 URS+ARD 组。然后，根据结石位置比较两组的无石率、费用等标准。无石定义为无结石残留。
结果
对于距离输尿管肾盂连接部（UPJ）≤30mm 的结石，URS 组术后 1 天和 1 个月的无石率分别为 80%和 80%，URS+ARD 组分别为 71.4%和 78.6%。对于距离 UPJ 31-90mm 的结石，URS 组术后 1 天和 1 个月的无石率分别为 84.7%和 84.7%，URS+ARD 组分别为 89.6%和 95.5%，1 个月时有统计学差异。对于距离 UPJ>90mm 的结石，两组均无结石。在 URS+ARD 组中，费用较高。此外，来自距离 UPJ 31-90mm 结石的残余结石的平均直径明显较小，其中 4 个在 1 个月内自然排出，明显多于其他部位和 URS 组。其他结果，包括手术时间和术后住院时间，两组之间无显著差异。
结论
逆行排斥装置确实有帮助，但对于仅位于上段输尿管中部的结石可能具有成本效益，而对于太靠近或远离输尿管肾盂连接部的结石则不然。
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