不同途径腔内碎石治疗输尿管上段嵌顿结石的疗效对比

A comparison of curative effect of using different endoscopic lithotripsy in treating impacted upper ureteral calculi

目的探讨腔内碎石治疗输尿管上段嵌顿结石的最佳途径。方法将94例体外冲击波碎石(ESWL)失败的输尿管上段嵌顿结石患者随机分组,50例采用经尿道输尿管镜碎石(URL),44例经皮肾微造瘘输尿管镜碎石(MPCNL),并对临床资料进行比较。结果URL组术后1周结石清除率22.00%,其余病例均因结石或较大碎石漂移到肾内而需联合ESWL,联合ESWL后1个月结石清除率为96.00%。MPCNL组术后1周结石清除率为95.45%,1个月结石清除率为97.73%。其中1例血尿明显,持续8d后停止。结论MPCNL治疗输尿管上段嵌顿结石疗效更佳,结石清除率高。单用URL治疗效果较差,而联合ESWL可达到满意效果。

[Objective] To investigate the best approach of endoscopic lithotripsy in treating impacted upper ureteral calculi. [Methods] To randomly assign 94 cases of impacted upper ureteral calculi with failure of extracorporeal shock wave lithotripsy （ESWL）, 50 of them were treated with trans-urethral ureteroscope lithotripsy （URL） and 44 with minimally invasive percutaneous nephrolithotomy （MPCNL）, and then the clinical material were analyzed. [Results] The stone-free rate of one week after operation in URL group was 22.00%, all the rest cases needed for combination ESWL because of the calculi or some bigger fragments moving into the kidney, in combination with ESWL one month later the stone-free rate was 96.00%. In MPCNL group, the stone-free rate of one week and that of one month after operation were 95.45% and 97.73% respectively. One case of MPCNL had hematuria apparently due to percutaneous nephrostomy and the symptom lasted 8 days. [Conclusion] MPCNL was more effective in treating impacted upper ureteral calculi and had higher stone-free rate. The curative effect of using URL alone in treating impacted upper ureteral calculi was poor, but in combination with ESWL, the satisfactory results also can be obtained.