微创经皮肾取石和经尿道输尿管镜碎石治疗输尿管上段嵌顿性结石的疗效观察

Effect of Minimally Invasive Percutaneous Nephrolithotomy and Transurethral Ureteroscope Lithotripsy in the Treatment of Impacted Upper Ureteric Calculi

【目的】比较微创经皮肾穿刺取石术（MPCNL）与经尿道输尿管镜碎石术（URL）治疗输尿管上段嵌顿性结石的疗效。【方法】回顾分析86例单侧输尿管上段结石患者的临床资料，52例采用MPCNL进行治疗；34例采用URL治疗，对比分析两组手术时间、结石清除率和术后高热（〉38．5℃）发生率。【结果】两组手术时间和术后高热发生率比较，差异无显著性（P〉0．05）。MPCNL纽术后住院时间为（8。4±2．7）d，多于uRL组（5．2±2．8）d，两组差异有显著性（P〈0．05）。3d、1个月结石清除率MPCNL组为94．2％（49／52）、98．1％（51／52），URL组为32．4％（11／34）、86．1％（29／34），两组差异有显著性（P〈0．05）。【结论】MPCNL治疗嵌顿性输尿管上段结石有较高的结石清除率，优于URL。

[Objective]To compare the effect of minimally invasive percutaneous nephrolithotomy（MPCNL） and transurethral ureteroscope lithotripsy（URL） in the treatment of impacted upper ureteric calculi. [Methods] The clinical data of 86 patients who had impacted upper ureteric calculi were retrospectively reviewed. Among all patients, 52 cases accepted MPCNL and 34 cases accepted URL. The operation time, clearance rate of the stone and the incidence of postoperative hyperpyrexia were statistically analyzed. [Results]No significant difference was detected in the operation time and the rate of postoperative hyperpyrexia between the two groups（ P〉0.05）. The hospital time of the MPCNL group was significantly more than that of the URL group. On the three days and one month after the operation, the stone clearance rate was 94.2 （49/ 52）and98.1（51/ 52）for MPCNL, 32.4 %（11/34） and 86. 1%（29/34）for URL. The stone clearance rate of URL was lower than that of MPCNL（ P d0.05）. [Conclusion] High stone clearance rate can be obtained with MPCNL for impacted upper ureterie calculi. The stone clearance rate is less satisfactory with URL.