微通道经皮肾镜碎石术与负压组合式输尿管镜碎石术治疗输尿管上段结石的临床研究

Clinical study of microchannel percutaneous nephrolitho-tomy and negative pressure combined ureteroscopic lithotripsy in the treatment of upper ureteral calculi

探讨微通道经皮肾镜取石术(MPCNL)与负压组合式输尿管镜碎石术(NPCU)治疗输尿管上段结石的临床效果。采用回顾性分析的方法,将120例输尿管上段结石患者均分为两组。行微通道经皮肾镜碎石术患者为MPCNL组,行负压组合式输尿管镜碎石术患者为NPCU组。结果显示:与NPCU组比较,MPCNL组患者术中出血量增加(P<0.05),住院时间明显延长,术后第1天、术后1个月结石清除率显著升高(P<0.05),并发症发生率明显增高(P<0.05);MPCNL组肠功能恢复时间、术后固体进食时间较NPCU组相对延长,但差异无统计学意义(P>0.05);结果表明,微通道经皮肾镜碎石术与负压组合式输尿管镜碎石术均是治疗输尿管上段结石的有效手段,均不会对肝肾功能造成不利影响。相对于微通道经皮肾镜碎石术,负压组合式输尿管镜碎石术具有创伤小、住院时间短等优点,但微通道经皮肾镜碎石术结石清洁率更高,特别对于输尿管上段结石直径较小,结石位置较高的患者更适用。临床上在选择具体手术方式时,应该根据具体情况进行选择。

To explore the clinical effect of micro-channel percutaneous nephrolithotomy combined with negative pressure ureteroscopic lithotripsy in the treatment of upper ureteral calculi.120 cases of upper ureteral calculi were randomly divided into two groups,60 cases in each group.MPCNL group was treated with microchannel percutaneous nephrolithotomy and NPCU group was treated with negative pressure combined ureteroscope lithotripsy.The results showed that compared with NPCU group,the intraoperative blood loss of patients in MPCNL group increased significantly(P<0.05).Compared with NPCU group,the recovery time of intestinal function and the time of solid food intake were longer in MPCNL group,but there was no significant difference(P>0.05).Compared with NPCU group,the hospital stay of MPCNL group was significantly longer.Compared with NPCU group,the incidence of complications in MPCNL group increased significantly(P<0.05).There was no significant difference(P<0.05).So Microchannel percutaneous nephrolithotripsy and negative pressure combined ureteroscopic lithotripsy are both effective methods for the treatment of upper ureteral calculi,which do not adversely affect liver and kidney function.Compared with microchannel percutaneousnephrolithotripsy,negative pressure combined ureteroscope lithotripsy has the advantages of less trauma and shorter hospitalization time.However,microchannel percutaneous nephrolithotripsy has a higher stone cleaning rate,especially for patients with smaller diameter of upper ureteral calculi and higher stone location.Clinically,the choice of specific surgical methods should be based on the specific situation.