输尿管镜气压弹道碎石术与微创经皮肾镜取石术治疗输尿管上段嵌顿结石合并感染的对比研究

A comparative study of ureteroscopic pneumatic lithotripsy and minimally invasive percutaneous nephrolithotomy for the treatment of upper ureter caculi combined with renal intrarenal infection

目的探讨经尿道输尿管镜气压弹道碎石术(URL)、微创经皮肾镜取石术(MPCNL)治疗输尿管上段嵌顿结石合并感染的疗效与安全性。方法回顾分析2007年7月至2011年7月该院收治的输尿管上段嵌顿结石合并感染的共126例,其中58例采用URL,68例采用MPCNL,比较两组的手术时间、碎石成功率、结石清除率、术后辅助治疗、术后并发症发生率、住院时间等疗效指标。结果 URL组手术成功48例(碎石成功率为82.76%),MPCNL组手术成功68例(碎石成功率为100.00%);URL组术后1周结石清除率为62.07%(36/58),MPCNL组术后1周结石清除率为98.53%(67/68),两组比较差异有统计学意义(P<0.05);术后1个月结石清除率,MPCNL组为100%,较URL组81.03%(47/58)明显提高(P<0.05);URL组术后辅助体外震波碎石治疗率为37.93%(22/58),而MPCNL组为1.47%(1/68),差异有统计学意义(P<0.05);URL组和MPCNL组手术时间分别为(65.34±26.72)min和(96.32±30.94)min,差异有统计学意义(P<0.05),URL组和MPCNL组住院时间分别为(4.54±1.87)d和(7.62±1.93)d,差异有统计学意义(P<0.05);URL组和MPCNL组,两组术后高热(T>39.0℃),分别发生5例和6例,差异无统计学意义(P>0.05);术后血培养阳性,URL组和MPCNL组分别为2例和3例,差异无统计学意义(P>0.05);URL组和MPCNL组术后血红蛋白下降发生率比较,差异无统计学意义(P>0.05)。结论 MPCNL较URL治疗输尿管上段嵌顿结石合并感染,具有更高的手术成功率和结石清除率,安全有效,是治疗输尿管上段嵌顿结石合并感染的首选疗法。

Objective To explore the safety and efficiency of patients with impacted upper ureter calculus combined with renal intrarenal infection treated by ureteroscopic pneumatic lithotripsy （URL ） and minimally invasive percutaneous nephrolithotomy （MPCNL） .Methods 126 cases of impacted upper ureteral calculi combined with renal intrarenal infection were treated in this hos-pita1 from July 2007 to July 2011 ,including 58 cases of URL ,68 cases of MPCNL .The success rate of primary lithotripsy ,stone-free rate ,postoperative adjuvant therapy ,operative time ,hospital stay ,incidence of postoperative complications and other data were analyzed .Results The success rate of group URL was 82 .76% （48/58） ,the success rate of group MPCNL was 100 .00% .The stone-free rate seven day after operation ：URL was 62 .07% （36/58） ,MPCNL was 98 .53% （67/68）（P〈0 .05） .The stone-free rate was 100 .00% in MPCNL group and 81 .03% in URL group one month After operation（P〈0 .05） .In MPCNL group ,the rate of adjuvant ESWL was 1 .47% ,significantly lower than 37 .93% in URL group（P〈0 .05） .In URL group the operative time （65 .34 ± 26 .72）min and hospital stay（4 .54 ± 1 .87）d were significantly shorter than those （96 .32 ± 30 .94）min and（7 .62 ± 1 .93）d in URL group（P〈0 .05） .After the operation ,in MPCNL group ,6 patients developed high fever ,in URL group ,5 patients had high fever （P〈0 .05） .Culture of blood after operation found 3 patients and 2 patients in MPCNL group and URL group were positive（P〈0 .05） .There were no significant differences in the rates of hemoglobin decline between the two groups （P〉0 .05） .Conclusion It has higher successful rate and stone-free rate in patients with upper ureter calculus combined with renal intrarenal infection by MPCNL than those treated by URL .The safety and efficency of the former is better that of the latter .MPCNL can be the first choice for the upper ureter calculus combined with renal intrarenal infection .