微创经皮肾取石和经尿道输尿管镜碎石治疗复杂性输尿管上段结石疗效比较

Comparison between Minimally Invasive Percutaneous Nephrolithotomy and Transurethral Ureroscopic Lithotripsy for Impacted Upper Ureteric Calculi

目的比较经皮肾穿刺取石术(MPCNL)与经尿道输尿管镜碎石术(URL)联合钬激光碎石治疗复杂性输尿管上段结石的疗效。方法回顾分析2006年1月至2007年8月应用MPCNL和URL治疗的复杂性输尿管上段结石74例的临床资料,比较两种方法的碎石时间、碎石率、清石率、平均住院日、并发症发生率等临床相关指标的差异。结果MPCNL组(n=38)的碎石率为100%(38/38),清石率术后3 d、1月分别为94.7%(36/38)、100%(38/38),平均手术时间(30.6±10.8)min,术后平均住院(5.6±1.1)d,术后发热1例。URL组(n=36)的碎石率为86.1%(31/36),清石率术后3 d、1月分别为66.7%(24/36)、83.3%(30/36),平均手术时间(51.7±11.6)min,术后平均住院(3.2±1.2)d,4例辅助体外冲击波碎石术(ESWL)治疗后结石排尽,无严重并发症。MPCNL的碎石率和清石率优于URL(P<0.05)。结论MPCNL和URL两种方法联合钬激光均可用于治疗复杂性输尿管上段结石。

Objective To investigate the effect of the minimally invasive pecutaneous nephrolithotomy（MPCNL）by holmium laser in management of impacted, upper ureteric calculi, comparing with thans-urethral ureteroscope lithotripsy （URL） by holmium laser. Methods Seventyfour cases were analyzed including the average time of lithotripsy, the rate of the overall fragment, the rate of the stonecompletely expelled,the average hospital stay, and the rate of complications. Results Thirty-eight patients were treated by MPCNL and 36 were treated by URL. After MPCNL, the average time of lithotripsy was （30.6±10. 8）min, the overall fragment rate was 100%（35/35）, the stone-free rate was 97. 1%（34/35） in 3 days postoperation, and it was 100%（35/35） in 1 month postoperation. The average hospital stay was （5.6±1.1）days. A pa-tient got fever postoperation. After URL, the average time of lithotripsy was（ 51.7±11.6）min, the overall fragment rate was 86. 1% （31/36）, the stone-free rate was 66. 7% （24/36）in 3 days postoperation, and it was 83.3% （30/36）in 1 month postoperation. The average hospital stay was（ 3.2±1.2 ）days. Four patients were treated by the auxiliary extracorporesl shock wave lithotripsy （ESWL）, the stone was completely expelled, the overall fragment rate and the stone-free rate of MPCNL were better than that of URL（P〈0.05）. Conclusion Combinated with holmium laser, both MPCNL and URL in treatment of impacted upper ureteric calculi were effective.