微创治疗输尿管上段结石258例报告

Minimally invasive management for upper ureteral calculi: Report of 258 cases

目的 探讨经尿道输尿管镜取石术（transurethral ureteroscope lithotripsy，URL）与微创经皮肾穿刺取石术（minimally invasive percutaneous nephrolithotomy，MPCNL）治疗输尿管上段结石的疗效及影响因素。方法 回顾性分析2001年1月～2004年12月我院258例输尿管上段结石的临床资料，225例采用URL治疗，33例采用MPCNL治疗。结果 URL单次碎石成功率73．8％（166／225），失败率26．2％（59／225）。失败原因：结石返回肾内18．7％（42／225）；操作失败6．2％（14／225）；因术中并发输尿管穿孔1例、断裂2例改开放手术1．3％（3／225）。MPCNL单次碎石成功率100％（33／33）。结论 输尿管狭窄、扭曲变形等是影响URL治疗的因素。MPCNL适应合并有继发病变、同侧肾结石的嵌顿性输尿管结石，有更高的结石取净率，且并发症少，安全性高。

Objective To evaluate clinical effects of the transurethral ureteroscopic lithotripsy （URL） and minimally invasive pereutaneous nephrolithotomy （MPCNL） in the management of upper ureteral stones, Methods Clinical data of 258 patients diagnosed as having upper ureteral calculi from January 2001 to December 2004 in this hospital were retrospectively analyzed, The patients were given either URL （225 patients） or MPCNL （33 patients）, Results Of the URL, the stone-free rate on one session was 73, 8% （166/225） and the failure rate was 26, 2% （59/225）, The causes for the failure included stone movement to the renal pelvic in 42 patients （ 18. 7% , 42/225 ） , unsuccessful manipulation in 14 patients （6, 2% , 14/225） , and conversions to open surgery because of ureteral perforation in 1 patient and ureteral rupture in 2 patients （1.3% , 3/225）. Of the MPCNL, the stone-free rate on one session was 100% （33/33）. Conclusions The application of URL can be interfered with ureteral stricture and twist that are secondary to incarcerated ureteral stones. High stone-free rate, low incidence of complications, and satisfactory reliability can be expected using MPCNL, especially in patients with impacted ureteral calculi accompanied with secondary affection at the same side.