输尿管上段结石的微创治疗选择

Choice of the Way of Microtraumatic Treatment in the Proximal Ureteral Calculus

目的探讨输尿管上段结石的微创治疗方法选择。方法回顾分析2003年8月～2008年8月我院有随访资料的输尿管结石患者258例,采用体外冲击波碎石术(ESWL)、输尿管镜腔内气压弹道碎石术(URL)、输尿管镜腔内气压弹道碎石联合体外冲击波碎石术(URL+ESWL)以及经皮肾顺行输尿管结石碎石取石术(PCNL)分别治疗输尿管上段结石。结果ESWL组、URL组、URL+ESWL组、PCNL组结石清除率分别为64.4%(87/135)、68.7%(33/48)、78.1%(43/55)、90.0%(18/20);并发症发生率ESWL最低。结论ESWL在治疗输尿管上段结石方面有损伤小的特点,但单用时结石清除率低,配合URL能取得满意的疗效;对合并肾结石的输尿管结石PCNL是理想的选择。

Objective To explore the ideal way of microtraumatic treatment of proximal ureteral calculus. Methods From August 2003 to August 2008,258 cases of proximal ureteral calculus were treated by ESWL, transureteroscopic pneumatic lithotripsy （ URL）, ESWL combined with URL （ URL＋ ESWL ）, percutaneous nephrolithotomy （PCNL）. Results The success rate was 64.4 %（87/135） ,68.7% （33/48） ,78.1% （43/55）,90.0 %（18/20）in the ESWL, URL, URL＋ESWL, PCNL respectively. Conclusion ESWI has advantage of minimal trauma in treating proximal ureteral calculus, but the stone-free rate is lower than PC.NL. When combined with URL, the stone-free rate is increased. Moreover, PCNL can obtain higher stone-free rate. It is an ideal way of microtraumatic treatment of proxi- mal ureteral calculus accompanied with kidney calculus.