输尿管软镜下钬激光碎石与经皮肾镜钬激光碎石治疗输尿管上段结石的疗效比较

Comparison of Flexible Ureteroscopic Holmium Laser Lithotripsy vs.Percutaneous Holmium Laser Nephrolithotomy for the Treatment of Upper Ureteral Calculi

目的探讨长径≤2 cm的输尿管上段结石最佳微创手术方式。方法本院2012年7月至2013年12月收治的123例合并或不合并肾积水的单侧输尿管上段结石患者,其中60例采用输尿管软镜下钬激光碎石,63例经皮肾镜钬激光碎石。对比分析两种手术方式治疗的手术时间、术后血红蛋白下降值、术后住院天数、住院费用、碎石成功率及并发症。结果输尿管软镜组与经皮肾镜组的手术时间分别为（120±8）min、（90±5）min,术后血红蛋白下降值分别为（0.2±0.1）g/L、（30±8）g/L,术后住院天数分别为（4±0.5）d、（10±2.3）d,住院费用分别为（22006±1589.6）元、（15106±658.3）元,碎石成功率分别为100%、93.7%（59/63）。结论输尿管软镜钬激光碎石除手术时间长于经皮肾镜外,与之比较具有创伤少、住院时间短、碎石成功率高,并发症发生率低的优势,值得推广。

Obj ective]To explore the best minimally invasive operation of upper ureteral calculi with long diameter less than 2cm.[Methods]A total of 123 patients with or without hydronephrosis in our hospital from July 2012 to Dec.2013 were chosen.Among them,60 patients underwent flexible ureteroscopic holmium laser lithotripsy,while 63 patients underwent percutaneous holmium laser nephrolithotomy.Operation time,post-operative hemoglobin decline value,postoperative hospital stay,hospitalization cost,stone free rate and com-plications of two methods were compared.[Results]The operation time of flexible ureteroscopy group and percutaneous nephrolithotomy group was （120±8）min and （90±5）min respectively,and postoperative hemo-globin decline value was （0.2±0.1）g/L and （30±8）g/L respectively,and postoperative hospital stay was （4 ±0.5）d and （10±2.3）d respectively,and hospitalization cost was （22006±1589.6）yuan and （15106± 658.3）yuan respectively,and the stone free rate was 100% and 93.7%,respectively.[Conclusion]Although flexible ureteroscopic holmium laser lithotripsy has longer operation time than percutaneous nephrolithotomy, it has advantages such as small trauma,shorter hospital stay,higher stone free rate and little complication. Therefore,it is worthy of clinical promotion.