上尿路结石211例治疗方法探讨

The management of upper urinary tract calculi(report of 211 cases)

目的:评价上尿路结石不同治疗方法的疗效。方法:对采用5种不同治疗方法的211例上尿路结石患者的临床资料进行回顾性分析。结果:采用体外冲击波碎石术(ESWL)86例(41%),输尿管镜下气压弹道碎石术(URL)15例(7%),微创小切口开放手术15例(7%),开放手术辅助内镜取石术19例(9%),传统开放手术76例(36%)。ESWL治疗1个月后结石排净率为70%(60/86),2个月后结石排净率为77%(66/86),有3例发生输尿管石街,用URL或开放手术取净。URL对输尿管中下段结石取净率为100%,术中无输尿管穿孔、撕脱等并发症发生。微创小切口开放术结石取净率为87%,术中未输血。开放手术辅助内镜取石对肾结石的取净率为90%,术中未见肾皮质撕裂。传统开放手术结石取净率为86%,其中复杂性结石83%,术中术后输血7例(9%)。结论:上尿路结石可用腔内技术和ESWL治疗,微创小切口开放术、开放手术辅助内镜可提高复杂性结石的治愈率。

Objective： To evaluate the efficacy of different modalities in the management of upper urinary tract calculi. Method： The data of 211 cases of upper urinary tract calculi which were treated by 5 different treatment methods were analyzed retrospectively. Results： Among 211 cases 86cases （41%） were treated by extracorporeal lithotripsy （ESWL）, 15 cases （7%） by ureteroscopic lithotripsy （URL）, 15 cases （7%） by mini-incision open procedures, 19 cases（9%） by endoscopy applicated open surgery, and 76 cases （36%） by traditional open surgery. The stone free rate after ESWL was 70% （60/86） at 1 month, 77% （66/86） at 2 month. There were 3 stainstress after ESWL, and were rendered stone free with URL or open procedures. The stone free rate of URL was 100% for lower ureteral stones, There was no ureteral perforation and avulsion happened. The stone free rate of mini-incision open procedure was 87%, no transfusion required. 90% stone free rate for endoscopy applicated open procedures, There was no avulsion of the renal cortex. The average stone free rate by traditional open surgery was 86%, and 83% for complicated cases, 7 cases （9%） were required transfusion. Conclusion： Upper urinary tract calculi can be managed by endourologic techniques and ESWL, minimal incision procedures and open surgery combined with endoscopy, can improve the stone free rate of complicated upper tract calculi.