长径大于等于1．5厘米输尿管上段结石的腔内治疗

Upper-ureteral calculi ≥1.5 cm： treatment by endourological procedure

目的 比较经尿道输尿管镜取石术（URL）与微创经皮肾镜取石术（MPCNL）治疗长径≥1．5cm输尿管上段结石的疗效。方法 对58例长径≥1．5cm的输尿管上段结石分别采用URL（URL组，35例）和MPCNL（MPCNL组，23例）治疗，比较两组疗效。术前所有患者均做超声及IVU检查。结果 URL组中13例结石被完全清除，成功率37．1％（13／35）；8例结石部分返回肾盂，需结合体外冲击波碎石术（ESWL）；7例因输尿管扭曲严重，3例因输尿管狭窄，4例因术野不清改行MPCNL或开放手术；平均手术时间为38min。MPCNL组中21例经一次手术清除结石，成功率91．3％（21／23）；2例因患肾残留结石须行ESWL，平均手术时间为34min。两组成功率比较，差异有统计学意义。结论 相对于URL而言，MPCNL是一种治疗长径≥1．5cm输尿管上段结石安全而有效的方法。

Objective To compare ureteroscopic lithotomy（URL）and minimally invasive percuta- neous nephrolithotomy （MPCNL） for the management of upper-ureteral calculi ≥1.5 cm. Methods Fifty-eight patients with upper-ureteral calculi ≥ 1.5 cm were selected in randomized for URL group （35 patients）or MPCNL group （23 patients）. Ultrasonography and intravenous X-ray were performed for all patients before surgery. Results In the URL group, 13 cases （37.1%）were rendered stone-free, 8 stones migrated upward to the pelvis of kidney. In these cases,a double- J stent was inserted,and ESWL was performed,7 cases had ureteral distortion, 3 cases had ureteral stricture, 4 cases had bad field of vision, MPCNL or open operation was performed in these cases. The mean operative time was 38 minutes （range 25-48 minutes）. In the MPCNL group,21 cases （91.3%）were rendered stone-free. In the other 2 patients,ESWL was performed because the stone fragments migrated upward to the pelvis of kidney. The mean operative time was 34 minutes （range 20-58 minutes）. Conclusion Compared with URL,MPCNL is a safe and effective procedure for treating upper-ureteral calculi ≥ 1.5 cm.