输尿管上段结石的微创外科治疗（附146例报告）

Minimally invasive surgical treatment for upper ureter stone （report of 146 cases ）

目的探讨输尿管上段结石的微创外科治疗方法。方法146例输尿管上段结石患者，根据病史及影像学检查分析是单纯性结石还是复杂性结石。采用体外冲击波碎石术（ESWL）治疗单纯性结石，治疗无效的患者按复杂性结石处理。采用输尿管镜下碎石术（URL）及URL联合ESWL治疗复杂性结石。URL失败的患者改行微创经皮肾穿刺取石术（MPCNL）。结果初步诊断单纯性结石97例，复杂性结石49例。ESWL治疗输尿管上段单纯性结石成功率为90．7％（88／97）。9例ESWL无效改行URL。URL及URL＋ESWL治疗输尿管上段复杂性结石的成功率为86．2％（50／58）。8例URL失败改行MPCNL，治疗成功率为100．0％（8／8）。结论应当充分尊重患者本人的意愿，从经济、安全、有效的角度，按无创-微创-轻创的顺序选择治疗输尿管上段结石的方法。

Objective To discuss minimally invasive surgical treatment for upper ureter stone. Methods There were 146 cases of upper ureter stone. There were two types of stone by diagnosis standards： simple stone and complicated stone. The patients with simple stone were treated by extracorporeal shock wave lithotripsy （ESWL）. The patients who could not be treated successfully by ESWL were treated as the case of complicated stone. Ureteroscope lithotripsy（URL） or URL combined with ESWL was used to treat complicat- ed stone. The patients who failed to be treated by URL were treated by minimally invasive percutaneous nephrolithotomy（MPCNL）. Results There were 97 cases of simple stone and 49 cases of complicated stone by initial diagnosis. The success rate for the treatment of simple stone in the upper ureter by ESWL was 90.7%（ 88/97 ）. Nine patients who failed to be treated by ESWL were treated by URL. The success rate for the treatment of complicated stone in the upper ureter by URL or URL combined with ESWL was 86.2% （50/58）. Eight patients who failed to be treated by URL were treated by MPCNL. The success rate of MPCNL was 100.0% （8/8）. Conclusions Patients＇ wishes should be respected. Based on the angle of economics, safety and effectiveness, the sequence of the treatment for upper ureteral stone should be selected from non-invasive, minimally invasive to little invasive treatment.