四种治疗方法处理上尿路结石的疗效比较

Comparing the Effective of Four Treatments for Upper Urinary Calculi

目的:分析上尿路结石的各种处理方法,探讨临床治疗中合理的治疗方案选择。方法:回顾性分析1130例上尿路结石患者的临床资料,比较各种治疗方法的治疗效果。其中,采用体外冲击波碎石术(ESWL)治疗412例;采用输尿管镜下气压弹道碎石术治疗380例;采用微创经皮肾镜微造瘘碎石术(PCNL)治疗66例;采用传统开放性手术治疗272例。结果:ESWL412例,结石清除率为86.4%;输尿管镜下气压弹道碎石术380例,结石清除率92.3%;PCNL66例,结石清除率98.3%;开放性手术272例,结石清除率97.6%。ESWL失败改输尿管镜下气压弹道碎石术36例,开放手术切开取石18例,占13.1%,输尿管镜下气压弹道碎石术失败改开放手术13例,占3.4%。结论:上段输尿管结石、尤其是I类结石宜采用ESWL。中下段输尿管结石、II类结石宜采用输尿管镜下气压弹道碎石术。对于复杂性结石,开放手术仍有实际应用价值。但大部分的上尿路结石均可采用PCNL,其拥有适应证广,效果明显等优势,已逐渐成为处理复杂性上尿路结石的首要治疗手段。

Objective：To analyse the treatments for upper urinary calculi,in order to choose a rational method for it.Method： We retrospectively analysed 1130 cases datas of the patients with upper urinary calculi.then compared the treatment effect.Above all,we treated with ESWL for 412 patients,and ureteropyeloscopic lithotripsy for 380 patients,and m-PCNL for 66 patients,and traditional surgical operation for 272 patients.Result： The calculi clearance rate： ESWL was 86.4%.Ureteropyeloscopic lithotripsy is 92.3%,m-PCNL is 98.3%,Surgical operation is 97.6%.36 patients use ureteropyeloscopic lithotripsy and 18 patients use operation after the failure of ESWL,the rate was 13.1%.and 13 use surgical operation after the failure of ureteropyeloscopic lithotripsy,the rate was 3.4%.Conclusion： We may use ESWL for the patients with upper ureteral,especially I calculi.And use ureteropyeloscopic lithotripsy for the patients with middle and lower ureteral calculi,especially II calculi.The surgical operation still have practical value with the complicated calculi.But mostly we use m-PCNL with upper urinary calculi because of the large indication and visible resucts,and gradually become the chief treatment for complicated calculi.