MPCNL在老年输尿管上段结石患者中的应用价值

The application value of MPCNL in the treatment of elderly patients with upper ureteral calculi

目的 探讨微创经皮肾镜顺行取石术（MPCNL）在老年输尿管上段结石患者中的应用价值,以期为临床治疗老年输尿管上段结石的术式选择提供参考依据.方法 选取2010年3月-2012年10月本院泌尿外科收治的182例老年输尿管上段结石患者为研究对象,根据术式的不同分为两组.行逆行输尿管镜碎石术（URL）治疗患者103例（URL组）,行微创经皮肾镜顺行取石术治疗患者79例（MPCNL组）.收集两组患者性别构成、年龄、结石大小、并发症种类、手术时间、术后住院日、并发症发生率、结石清除率及伴发疾病情况,并进行统计学分析.结果 两组患者平均年龄、性别构成比、结石大小、并发症种类、手术时间、并发症发生率及伴发疾病情况组间比较差异不明显,结果无统计学意义（P＞0.05）,MPCNL组术后平均住院日较高于URL组（t=6.931,P=0.000）,结石清除率较URL组明显升高（x2=26.506,P=0.000）,差异有统计学意义.结论 MPCNL较URL在治疗老年输尿管上段结石方面能更有效的提高结石清除率,可作为临床中治疗老年输尿管上段结石的首选方案.

Objectives To investigate the application value of minimally invasive percutaneous nephrolithotomy lithotripsy （MPCNL） in the treatment of elderly patients with upper ureteral calculi.Hope to provide a reference surgical options for the clinical treatment of elderly upper ureteral calculi.Methods 182 cases of elderly patients with upper ureteral stones were selected in our hospital from May,2010 to October,2012.According to different surgical procedures,the patients were divided into two groups.103 patients were treated by the retrograde ureteroscopy （URL） （URL group）,while the rest 103 patients were treated by the minimally invasive percutaneous nephrolithotomy lithotripsy （MPCNL group）.Gender,age,stone size,type of complications,operative time,postoperative hospital stay,incidence of complications,stone clearance rate and concomitant disease situation were recorded and statistically analyzed between two groups.Results There was no significant difference in the mean age,gender ratio,stone size,type of complications,operative time,complications and comorbidities between the two groups（P 〉0.05）.The postoperative hospital stay in MPCNL group was shorter than in URL group（t =6.931,P =0.000）,and the stone clearance rate was higher than in URL group （x2 =26.506,P =0.000）,which was considered statistically significant.Conclusions MPCNL in the treatment of elderly patients with ureteral calculi can more effectively improve aspects of stone clearance rate compared with URL.It can be used as the preferred solution in the treatment of elderly patients with ureteral calculi.