微创经皮肾穿刺取石和经尿道输尿管镜碎石治疗嵌顿性输尿管上段结石的疗效比较

The comparison of Minimally Invasive Percutaneous Nephrolithotomy and Trans-urethral Ureteroscope Lithotripsy for impacted upper ureteric calculi

目的 :比较微创经皮肾穿刺取石术 (MPCNL)与经尿道输尿管镜碎石术 (URL)治疗嵌顿性输尿管上段结石的疗效。方法 :对 2 0 2例单侧嵌顿性输尿管上段结石患者 ,92例采用MPCNL治疗 (MPCNL组 ) ,110例采用URL治疗 (URL组 ) ,其中 4 6例接受辅助的ESWL治疗。结果 :MPCNL组术后 3天结石清除率为 94 .6 % (87/92 ) ,术后 1个月结石清除率为 10 0 % (92 / 92 )。URL组术后 3天结石清除率为 2 0 .9% (2 3/ 110 ) ,术后 1个月结石清除率为 84 .5 % (93/ 110 )。结论 :MPCNL治疗嵌顿性输尿管上段结石有很高的结石清除率 ;URL治疗效果稍差 ,可以联合体外冲击波碎石来提高疗效。但二者可以根据患者病情酌加选用。

Objective:To investigate the effect of the Minimally Invasive Percutaneous Nephrolithotomy(MPC NL) in management of impacted upper ureteric calculi,comparing with Trans-urethral Ureteroscope Lithotripsy(URL).Methods:A total of 202 patients were diagnosed as impacted upper ureteric calculi, 92 patients received Minimal Invasive Percutaneous Nephrolithotomy, 110 patients received Trans-urethral Ureteroscope Lithotripsy, 46 patients received auxiliary Extracorporeal Shock Wave Lithotripsy. The stone-free rate was recorded in 3 days and 1 month postoperation.Results:After MPCNL, the stone-free rate was 94.6 %(87/92) in 3 days postoperation,and it was 100% ( 92/92) in a month postoperation. After URL ,the stone-free rate was 20.9 %(23/110) in 3 days postoperation. With the auxiliary ESWL, the stone-free rate was 84.5%(93/110) in a month postoperation.Conclusions:High stone-free rate can be obtained with Minimally Invasive Percutaneous Nephrolithotomy for impacted upper ureteric calculi. The stone-free rate was less effective with Trans-urethral Ureteroscope Lithotripsy, but the result can be raised with the auxiliary ESWL.