3种不同术式治疗复杂输尿管上段结石的疗效比较——随机对照研究

A comparison of three surgical procedures for complicated upper ureteral calculi

目的比较体外冲击波碎石（extracorporeal shock wave lithotripsy，ESWL）、逆行输尿管镜取石（ureteroscope lithtripsy，URL）联合ESWL、微创经皮肾镜取石（minimally invasive percutaneous nephrolithotomy，MPCNL）治疗复杂输尿管上段结石的疗效。方法分析2002年12月-2003年12月我院治疗复杂输尿管上段结石234例，其中ESWL治疗76例，URL联合ESWL治疗78例．MPCNL治疗80例。结果ESWL组一次碎石成功率56，6％（43／76），术后1个月结石清除率46，l％（35／76），平均费用912元，术后并发症发生率15，8％（12／76）；URL联合ESWL组碎石成功率100％（78／78），术后1个月结石清除率83．3％（65／78），平均费用7720元，术后并发症发生率15，4％（12／78）；MPCNL组碎石成功率100％（80／80），术后1个月结石清除率100％（80／80），平均费用10253元，术后并发症发生率13．8％（11／80）。MPCNL组手术时间、术中出血量、住院时间、术后1个月结石清除率和费用明显高于ESWL和URL联合ESWL组；一次碎石成功率MPCNL组与URL联合ESWL组相比无明显差异，均明显高于ESWL组；3组术后并发症发生率比较无明显差异。结论MPCNL治疗复杂输尿管上段结石安全有效，可成为治疗复杂输尿管上段结石的首选治疗方法。

Objective To compare the efficacy of three procedures, extracorporeal shock wave lithotripsy （ESWL）, ureteroscopic lithotripsy （URL） combined with ESWL, and minimally invasive percutaneous nephrolithotomy （MPCNL）, for the treatment of complicated upper ureteral calculi. Methods Two hundred and thirty-four cases of complicated upper ureteral calculi were treated in this hospital from December 2002 to December 2003, including 76 cases of ESWL, 78 cases of combined use of URL and ESWL, and 80 cases of MPCNL. Results In the ESWL cases, the stone fragmentation rate on one session was 56. 6% （43/76） , the stone-free rate one month after operation was 46.1% （35/76） , the mean hospitalization expenditure was 912 yuan, and the incidence of postoperative complications was 15.8% （12/76）. In the URL combined with ESWL cases, the stone fragmentation rate on one session was 100% （78/78） , the stone-free rate one month after operation was 83.3% （65/78） , the mean hospitalization expenditure was 7 720 yuan, and the incidence of postoperative complications was 15.4% （12/78）. In the MPCNL cases, the stone fragmentation rate on one session was 100% （80/80） , the stone-free rate one month after operation was 100% （80/80） , the mean hospitalization expenditure was 10 253 yuan, and the incidence of postoperative complications was 13.8% （11/80）. The operation time, intraoperative blood loss, length of hospital stay, stone-free rate one month after operation, and hospitalization expenditure were significantly greater in the MPCNL eases than in the ESWL cases and the URL combined with ESWL cases. The stone fragmentation rate on one session was not significantly different between the MPCNL cases and the URL combined with ESWL cases, and was significantly higher in the MPCNL cases and the URL combined with ESWL cases than in the ESWL cases. The incidence of postoperative complications was not significantly different among the three groups. Conclusions Minimally invasive percutaneous nephrolithotomy should be used as the first choice for complicated upper ureteral calculi.