标准通道与微通道经皮肾镜取石术治疗输尿管上段结石疗效的比较

Comparison of Standard-tract and Mini-tract Percutaneous Nephrolithotomy in the Management of Upper Ureteral Stones

目的 比较标准通道和微通道经皮肾镜取石术（percutaneous nephrolithotomy，PCNL）治疗输尿管上段结石的临床效果。方法 回顾性分析PCNL治疗67例输尿管上段结石的临床资料，根据不同工作通道分为标准通道组（n=36）和微通道组（n=31），比较2组手术时间、术后结石清除率、并发症等。结果 2组在手术时间[（42.3±8.9）min vs.（46.3±10.4）min，t=-1.697，P=0.095]、一期结石完全清除率[97.2％（35／36）vs.93.5％（29／31）,X^2=0.018，P=0.894]、术后血红蛋白下降值[（12.3±4.9）g／L vs.（11.0±4.7）g／L，t=1.103，P=0.274]和住院时间[（6.4±1.O）d vs.（6.2±1.0）d，t=0.816，P=0.417]均无统计学差异。并发症发生率如输血[8.3％（3／36） vs.6.5％（2／31），X^2=0.000，P=1.000]，发热[13.9％（5／36）vs.12.9％（4／31），X^2=0.000，P=1.000]，输尿管穿孔[0 vs.3.2％（1／31），P=0.463]均无统计学差异。67例术后随访0.5～3年，平均1.2年，无肾功能丧失、肾周积液、复发性尿路感染、输尿管狭窄等。结论 标准通道和微通道PCNL治疗输尿管上段结石的临床疗效与安全性无明显差别。

Objective To compare the efficacy of standard-tract and mini-tract percutaneous nephrolithotomy （PCNL） in the management of upper ureteral stones. Methods We carried out a retrospective analysis on the clinical data of 67 patients with upper ureteral stones undergoing PCNL. The patients were divided into standard-tract PCNL group （n = 36） and mini-tract PCNL group （n = 31 ）. The operative time, postoperative stone clearance rate and complications of the two groups were compared. Results No significant differences were observed in the operative time [ （42.3 ± 8.9） rain vs. （46.3 ± 10.4） min, t = - 1.697, P = 0. 095], first-stage stone clearance rate [97.2% （35/36） vs. 93.5% （29/31）, X^2 =0.018, P =0.894], hemoglobin drop values [（12.3 ± 4.9） g/L vs. （11.0±4.7） g/L, t=1.103, P =0.274] and hospital stay [（6.4＋1.0）d vs. （6.2 ±1.0）d, t =0.816, P=0.417 ] between the two groups. No significant difference in the incidence of complications such as blood transfusion [8.3% （3/36） vs. 6.5% （2/31）,X^2 = 0.000, P = 1.000], fever [13.9% （5/36） vs. 12.9% （4/31）, X^2 =0.000, P = 1.000] and ureter perforation [0 vs. 3.2% （ 1/31 ） , P =0.463 ] was found between the two groups. All the patients were followed up for 6 months to 3 years with a mean of 1.2 years and no kidney dysfunction, hydroperinephrosis, recurrent urinary tract infection or ureter stenosis was observed. Conclusion The efficacy and safety of standard-tract and mini-tract percutaneous nephrolithotomy in the management of upper ureteral stones are comparable.