3种治疗输尿管中下段结石方法的比较

A comparative study of 3 kinds of methods for the treatment of middle and lower ureteral calculi

目的探讨输尿管中下段结石的最佳治疗方法。方法对经体外震波碎石(ESWL)、输尿管镜下气压弹道碎石术(PL)及开放输尿管切开取石术3种方法治疗的2358例输尿管中下段结石患者的临床疗效及并发症进行比较。结果 ESWL组846例,单次碎石成功476例(56.3%),4周后结石排净率为67.9%;PL组1370例,单次碎石成功1278例(93.3%),4周后结石排净率为97.1%;开放输尿管取石142例,取石成功率100%。术后疼痛、发热、恶心呕吐、血尿是3组常见的并发症,PL组术后疼痛、发热发生率最低,分别为3.5%、2.9%,3组比较差异有统计学意义(P<0.05)。结论 PL治疗输尿管中下段结石其结石清除率高、并发症少,可作为中下段结石的首选治疗方法。开放取石虽能完全取出结石,但创伤大,是其他治疗方式失败的补救措施。

Objective To explore the best means for the treatment of middle and lower ureteral calculi. Methods 2358 cases of patients with middle and lower ureteral calculi, who were treated by extracorporeal shock-wave lithotripsy （ES- WL） ,ureteroscopic pneumatic lithotripsy （PL） and open surgery, were compare. Results 846 cases were treated by ESWL, 1370 cases were treated by ureteroscopic pneumatic lithotripsy. The single stone clearance rate of ESWL and PL were 56.3%, 93.3% ,respectively. The stone free rate of of ESWL and PL in 4 weeks were 67.9% ,97.1% ,respectively. 142 cases were treated by open surgery and no failure. The same complications including pain,fever,nausea vomiting and hematuresis. Incision pain was very important complication in open surgery. The incidence of pain and fever was the lowest in PL group, which were 3.5 % and 2.9%, respectively. The difference of 3 groups was statistically significant （ P 〈 0.05 ）. Conclusion Ureteroscop- ic pneumatic lithotripsy is a safe and effective mean with less complications and complete clearance of the calculi, which can be as the first choice in the treatment of calculi in the middle and lower ureter. Open surgery can completely remove the stones, but the trauma is strong and is the remedial measures of all ureteral operation.