输尿管镜联合封堵器与微创经皮肾镜治疗输尿管上段嵌顿结石的疗效比较

A Comparative Study of Mini-invasive Percutaneous Nephrolithotomy and Ureteroscopic Lithotripsy Combined with Occlusion Devices for the Treatment of Upper Incarcerated Ureteral Stones

目的：比较微创经皮肾镜取石术（ minimally invasive percutaneous nephrolithotomy ，MPCNL）与经尿道输尿管镜碎石（ ureteroscopic lithotripsy ，URL）联合封堵器治疗输尿管上段嵌顿结石的疗效。方法我院2011年4月～2013年7月收治单侧输尿管上段嵌顿结石89例，42例行MPCNL，47例行URL碎石。结果2组一次性碎石成功率分别为97．6％（41／42）、95．7％（45／47），无统计学差异（χ2＝0．000，P＝1．000）；结石清除率分别为97．5％（40／41）、95．6％（43／45），无统计学差异（χ2＝0．000，P＝1．000）；术后并发症发生率分别为7．1％（3／42）、8．5％（4／47），无统计学差异（χ2＝0．000，P＝1．000）；手术时间分别为（80．2±11．9） min和（65．1±10．9） min，有统计学差异（ t＝6．248，P＝0．000）；住院时间分别为（7．3±1．5） d和（3．5±1．5）d，有统计学差异（t＝11．931，P＝0．000）。结论术中注意手术技巧，MPCNL与输尿管镜联合封堵器处理输尿管上段结石均可取得满意的效果。

Objective To compare the efficacy of ureteroscopic lithotripsy （ URL） combined with occlusion devices and mini-invasive percutaneous nephrolithotomy （ MPCNL） in the treatment of upper incarcerated ureteral stones. Methods A total of 89 patients with unilateral upper ureteral calculi were enrolled from April 2011 to July 2013, 42 of which were treated with MPCNL and 47 of which were treated by rigid ureteroscopic lithotripsy combined with occlusion devices. Resuts There were no significant differences in the success rate of primary lithotripsy （97.6% vs.95.7%, χ2 =0.000, P=1.000）.No marked differences were detected in the stone clearance rate （97.5% vs.95.6%, χ2 =0.000, P=1.000）, complication rate （7.1% vs.8.5%, χ2 =0.000, P=1.000） and operation time [（80.2 ±11.9） min vs.（65.1 ±10.9） min, t =6.248, P=0.000] between the two groups.The hospitalization time in the URL group was （3.5 ±1.5） d, which was obviously shorter than that in the MPCNL group , in which it was （7.3 ±1.5） d（t=11.931, P=0.000）. Conclusion URL combined with occlusion devices can obtain satisfactory results as well as MPCNL in the treatment of upper ureteral calculi by proper case selection and careful operation performance .