顺行与逆行输尿管镜技术处理输尿管上段嵌顿性结石的疗效比较

Comparison of the outcomes of antegrade and retrograde approach ureteroscopy for impacted upper ureteric calculi

目的比较顺行与逆行输尿管镜技术处理输尿管上段嵌顿性结石的疗效，并对其安全性与有效性进行评价。方法采用输尿管镜技术共治疗输尿管上段嵌顿性结石106例，其中顺行经皮肾微造瘘入路50例（顺行组），逆行经尿道人路56例（逆行组）。结果逆行组手术成功52例（92．9％），手术时间（45±5）min，住院时间（6±1）d，一期结石清除率80．4％（45／56），7例需体外冲击波碎石术（ESWL）辅助治疗，出现手术并发症3例（5．4％）；顺行组手术成功50例（100．0％），手术时间（55±8）min，住院时间（8±2）d，一期结石清除率100．0%（50／50），无手术并发症发生。两组一期结石清除率和并发症发生率比较差异有统计学意义（P〈0．05）。结论顺行与逆行输尿管镜技术处理输尿管上段嵌顿性结石均有较高的手术成功率，顺行人路的安全性与有效性更好，但手术时间及住院时间稍长。

Objective To compare the outcomes of antegrade and retrograde approach ureteroscopy for impacted upper ureteric calculi and assess the safety and efficiency of the two types of minimally invasive technique. Methods A total of 106 patients with impacted upper ureteric calculi were treated with ureteroscopy. The procedure was performed via antegrade percutaneous nephrostomy tract in 50 patients （antegrade group） and via retrograde transurethral access in 56 patients （retrograde group）. Results The success rate of retrograde group was 92.9% （52/56）. Operating time was （45 ± 5 ） min, hospital stay was （6 ± 1 ） days. The stone free rate was 80.4% （45/56） at 1 month follow-up,7 patients with residual calculi required ESWL combination. Comphcation rate was 5.4% （3/56）. The success rate of antegrade group was 100.0%（50/50）. Operating time was （55 ± 8） min, hospital stay was （8 ±2） days. The stone free rate was 100.0% （50/50） and no complication was noted. The stone free rate and the complication rate indicated significant difference between the two groups （P 〈 0.05）. Conclusions Antegrade and retrograde access ureteroscopy for impacted upper ureteric calculi are safe and effective. Success rate and stone free rate of antegrade approach are higher than those of retrograde approach.