F-URS与MPCNL治疗输尿管上段结石的随机对照临床研究

Randomized controlled study of flexible ureteroscopic lithotripsy and minipercutaneous nephrolithotomy for treating upper ureteral calculi

目的通过随机对照临床试验，比较输尿管软镜钬激光碎石术（F-URS）与微创经皮肾镜取石术（MPCNL）治疗输尿管上段结石的临床疗效和安全性。方法将2013年5～9月来该院治疗上段输尿管结石且符合研究纳入标准的患者120例，随机分为F-URS组和MPCNL组，每组60例，观察对比术后两组患者的临床疗效。结果F-URS组与MPCNL组初始结石清除率分别为68．33％和95．000，差异有统计学意义（P〈0．05），3个月后结石清除率分别为96．670．4和98．33％，两组差异无统计学意义（P〉0．05）；F—URS组和MPCNL组手术时间分别为（35．33±11．57）min和（53．75±17．31）min，术后住院日分别为（3．05±0．62）d和（5．43±1．84）d，术后第1天视觉模拟疼痛评分（VAS）分别为（1．70±1．37）分和（3．68±1．57）分，两组患者比较差异均有统计学意义（P〈0．05）；两组患者术后血红蛋白（Hb）下降量及并发症发生率比较，差异无统计学意义（P〉O．05）。结论对于有手术指征的输尿管上段结石，F-URS在结石清除率方面与MPCNL疗效相当，且其较MPCNL有更高的安全性及更短的术后住院时间，在有条件开展F-URS的科室应列为首选治疗方法。

Objective To compare the safety and efficacy of flexible ureteroscopic lithotripsy（F-URS） and mini-percutaneous nephrolithotomy（MPCNL） for treating upper ureteral calculi by the randomized controlled clinical trial. Methods 120 cases of up- per ureteral calculi treated in this hospital from May to September 2013 were randomized into the F-URS group and the MPCNL group with 60 cases in each group. The postoperative clinical curative effects were compared between the two groups. Results The initial stone clearance rates of the F-URS group and the MPCNL group were 68.33% and 95.00% respectively,and the difference was statistically significant （P〈0. 05）. The clearance rate of the two groups after postoperative 3 months were 96. 67% and 98.33% respectively,and the difference between the two groups had no statistical significance（P〈0.05）. The operating time of the F-URS group and the MPCNL group was （35.33 ± 11.57）min and （53.75 q-17.31） min respectively, the average hospital stay after operation was （3.05 _q- 0.62） d and （5.43 ± 1.84） d respectively, and the average visual analogue scale（VAS） score on first postoper- ative day was 1.70± 1.37 and 3.68 ± 1.57 respectively. These indicators had statistically significant differences between the two groups（P〈0.05）. The average dropped amount of hemoglobin and the occurrence rate of complications after operation had no sta- tistically significant differences between the F-URS group and the MPCNL group（P〉0.05）. Conclusion For upper ureteral calculi with surgical indication,the effect of F-URS is equivalence to MPCNL in the aspect of the stone clearance rate, but F-URS has high- er security and shorter postoperative hospital stay. In the department with the condition to conduct F-URS, F-URS should be ranked as the preferred treatment method for upper ureteral calculi.