气压弹道碎石术与微创经皮肾镜碎石术治疗输尿管上段结石的疗效比较

Comparison of Clinic Effect of Ureteroscopic Pneumatic Lithotripsy and Minimally Invasive Percutaneous Nephrolithotomy for the Treatment of Upper Ureter Caculi

目的比较气压弹道碎石术与微创经皮肾镜碎石术治疗输尿管上段结石临床疗效。方法共纳入输尿管上段结石187例,其中65例采用尿管镜气压弹道碎石,122例使用经皮肾镜取石术。比较两组手术时间、血红蛋白下降值、住院天数、碎石成功率、结石排尽率和并发症等疗效指标。结果手术时间气压弹道组明显短于经皮肾镜组;血红蛋白下降量气压弹道组明显低于经皮肾镜组;住院天数气压弹道组明显短于经皮肾镜组;碎石成功率和结石排尽率经皮肾镜组与气压弹道组相比有明显优势;术后并发症经皮肾镜组并发症明显少于气压弹道组。结论临床上应根据结石的部位、大小、停留时间、输尿管解剖等实际情况来对微创治疗法进行选择。对于输尿管上段较大结石、结石停留时间较长者宜首选微创经皮肾镜碎石术。

Objective To compare the clinical effect of upper ureter caculi by pneumatic lithotripsy and minimally invasive percutaneous nephrolithotomy.Methods 187 patient with upper ureter caculi were divided into two groups：group one include 65 cases underwent ureteroscopic pneumatic lithotripsy（UPL）the other group is 122 cases of minimally invasive percutaneous nephrolithotomy（MPCNL）.There were no significant differences in age,sex and diameter of stone in the two groups.Data of the operative time,value of hemoglobin decrease,hospitalization time,success rate of primary lithotripsy,stone-free rate and complication rate were analyzed.Results The UPL group had more advantage over the group MPCNL in the operative time,value of hemoglobin decrease and hospitalization time while group MPCNL was significantly higher than group UPL in the rate of stone-free and the success rate of primary lithotripsy.Conclusion The choice of the minmally invasive method should depend on the condition of the caculi position,volume,residence time and ureteral anatomy.MPCNL is the first choice for the upperureter calculi with bigger volume and longer residence time.