经皮肾镜和输尿管镜治疗嵌顿性输尿管上段结石的对比研究

Contrastive study of percutaneous nephrolithotomy and ureteroscopy for impacte dupper ureteral calculi

目的:对经皮肾输尿管镜取石术(PCNL)与经尿道输尿管镜取石术(URL)在治疗嵌顿性输尿管上段结石的治疗效果进行分析对比研究。方法:选取嵌顿性输尿管上段结石患者144例,按照治疗方式的不同将其分为PCNL组和URL组,每组72例。监测并比较两组患者碎石成功率、术后3 d和30 d结石清除率、手术耗时、平均住院时间和总费用。根据所得数据分析比较PCNL和URL在治疗嵌顿性输尿管上段结石的临床治疗效果。结果:PCNL组的碎石成功率、术后3 d和30 d结石清除率分别为95.8%(69/72)、93.1%(67/72)和98.6%(71/72),而URL组为80.6%(58/72)、76.4%(55/72)和81.9%(59/72),其差异有统计学意义(x2=5.18,x2=5.85,x2=6.49;P<0.05);但PCNL组的手术耗时、平均住院时间和总费用均大于URL组,其差异有统计学意义(t=3.80,t=4.87,t=5.34;P<0.05)。结论:PCNL与URL治疗嵌顿性输尿管上段结石相比,其结石清除效果更好,但存在费用高和住院时间长的问题,患者需要进行综合比较后选择合适的方式。

Objective：To compare the clinical effects of Percutaneous nephrolithotomy lithotripsy （PCNL） and transurethral ureteroscopy （URL） in the treatment of impacted upper ureteral calculi.Methods：Since 2008, There were 144 cases with incarcerated upper ureteral calculi in hospital, all patients were divided into two groups according to the different ways of treatment, the PCNL group with 72 cases and the URL group with another 72 cases. Monitor and record the rate of overall fragment, and the stone clearance rate of 3d and a month after the operation, average length of stay and total costs of the two groups. Through the Analysis to the data obtained, compare the clinical results of PCNL and URL in the treatment of impacted upper ureteral calculi.Results： For PCNL group, the rate of overall fragment, and the stone clearance rate of 3d and a month after the operation was 95.8% （69/72）, 93.1% （67/72） and 98.6% （71/72）, while for URL group, the data was 84.7% （61/72）, 83.3% （60/72） and 86.1% （62/72）, the difference was statistically significant （x2=5.18,x2=5.85,x2=6.49;P＆lt;0.05）; The operation time, average length of stay and total costs for PCNL group are greater than the URL group, and the difference was statistically significant（t=3.80, t=4.87,t=5.34;P＆lt;0.05）.Conclusion： PCNL compared with the URL in the treatment of impacted upper ureteral calculi has a better performance on stone clearance, but there are problems of higher costs and longer hospital stay. Accordingly, patients need a comprehensive comparison and choose the appropriate way.