输尿管镜气压弹道碎石术结合体外冲击波碎石治疗复杂性输尿管上段结石

Treatment of complicated upper ureter calculi with the combined use of ESWL and URSL

目的总结输尿管镜气压弹道碎石术结合体外冲击波碎石治疗复杂性输尿管上段结石的临床经验。方法62例复杂性输尿管上段结石患者随机分为2组:A组首先采用体外冲击波碎石1、2次,如无效改为输尿管镜气压弹道碎石;B组首先采用输尿管镜气压弹道碎石,术后根据情况采用体外冲击波碎石补充治疗。结果经3个月治疗,A组有12例残留结石,仍需ESWL或药物进一步治疗,结石排净率61.3%。B组27例排净结石,4例残留结石,结石排净率87.1%。二组差异具有显著性(P<0.05)。结论对于复杂性输尿管上段结石,首先采用输尿管镜气压弹道碎石,术后根据情况,补做体外冲击波碎石,可明显提高结石排净率。

[Objective] To summarize the clinical experience of the treatment of complicated upper ureteral calculi with the combined use of URSL and ESWL. [Methods] 62 cases of complicated upper ureteral calculi were divided into 2 groups randomly. Group A was treated by ESWL for 1-2 times, and then followed by URSL if ineffective. Group B was treated by URSL, and followed by ESWL if necessary according to the condition. [Results] After 3 months, the efficacy rate of group A and group B were 61.3% and 87.1% respectively. The difference was of great significance （P 〈0.05）. [Conclusions] We should firstly adopt URSL in the cases of complicated upper ureteral calculi. According to the condition, add ESWL to remote the stone free rate.