顺行经皮肾微造瘘与逆行经输尿管镜钬激光肾盂内切开术治疗肾盂输尿管连接部狭窄疗效比较

Effect Comparison of Antegrade Mini-invasive Percutaneous Nephrostomy with Retrograde Ureteroscopic Endopyelotomy for Ureteropelvic Junction Obstruction

目的比较顺行经皮肾微造瘘(antegrade mini-invasive percutaneous nephrostomy,MPCN)和逆行经输尿管镜(retrograde ureteroscopy,RUS)行钬激光肾盂内切开术治疗肾盂输尿管连接部狭窄(ureteropelvic junction obstruction,UPJO)的疗效。方法48例UPJO患者按照治疗方法分为MPCN组(28例)和RUS组(20例)。结果MPCN组无一例中转开放,平均手术时间(52.3±12.7)min、术中出血量(32.1±17.9)ml、术后住院时间(6.3±1.3)d、恢复工作时间(43.2±5.2)d、并发症发生率17.9%(5/28),随访治疗有效率为89.3%(25/28)。RUS组有4例中转开放或顺行腔内手术,平均手术时间(36.2±7.8)min、术中出血量(9.4±7.3)ml、术后住院时间(4.0±1.3)d、恢复工作时间(37.7±5.3)d、并发症发生率18.7%(3/16),随访治疗有效率56.2%(9/16)。两组并发症发生率比较差异无统计学意义(P>0.05),但手术时间、术中出血量、术后住院时间、恢复工作时间、手术有效率等比较差异均有统计学意义(P<0.05或P<0.01)。结论MPCN钬激光肾盂内切开术适合治疗合并感染、肾结石及开放手术后的UPJO患者,可作为部分UPJO患者的首选治疗方法。

Objective To compare the efficacy of two different mini-invasive methods for treating ureteropelvic junction obstruction(UPJO): holmium laser endopyelotomy by antegrade mini-invasive percutaneous nephrostomy(MPCN) and holmium laser endopyelotomy by retrograde ureteroscopy(RUS). Methods 48 UPJO cases were divided into two groups: 28 cases of MPCN group were performed MPCN holmium laser endopyelotomy,and 20 cases of RUS group were conducted RUS holmium laser endopyelotomy. Results No case conversed to open su...