输尿管镜取石与经皮肾镜取石治疗输尿管上段结石

Efficacy of Ureteroscopic Lithotomy and Percutaneous Nephrolithotomy for Upper Ureteral Calculi

目的探讨输尿管镜取石（ureteroscopic lithotomy,URL）与经皮肾镜取石（percutaneous nephrolithotomy,PCNL）治疗输尿管上段结石的疗效及安全性。方法回顾分析2009年3月-2013年7月北京大学人民医院113例单侧输尿管上段结石患者的临床资料。对于结石远端输尿管狭窄迂曲、尿流改道、结石长径≥1.5 cm、合并肾盂输尿管连接部狭窄的患者倾向于行PCNL,其中URL组60例,PCNL组53例。观察2组结石负荷、手术时间、术后发热、血红蛋白降低值、总住院时间及清石率等指标。结果 URL组结石大小为（1.0±0.3）cm,PCNL组为（1.4±0.4）cm。URL组1例结石上移至肾盂终止手术,其余112例均成功完成手术,取净结石。URL组和PCNL组手术时间分别为（54.0±24.4）min和（59.4±37.0）min,术后次日血红蛋白降低值为（4.3±5.7）g/L和（9.5±8.0）g/L,术后发热4例和6例,清石率为98.3%（59/60）和100%（53/53）,总住院时间为（6.4±2.1）d和（8.5±3.4）d。结论 URL和PCNL治疗输尿管上段结石均有效、安全,PCNL清石率较高,结石较大的患者可选择PCNL治疗,但住院时间更长。

Objective To investigate the efficacy and safety of ureteroscopic lithotomy（ URL） and percutaneous nephrolithotomy（ PCNL） in the treatment of upper ureteral calculi. Methods Clinical data of 113 patients with unilateral upper ureteral calculus from March 2009 to July 2013 in our hospital were analyzed retrospectively. PCNL was the preferential procedure for patients with distal ureteral stricture or circuity,urinary diversion,stone size 1. 5 cm,and ureteropelvic junction obstruction. There were 60 cases in URL group and 53 cases in PCNL group. The stone burden,operative time,postoperative fever,perioperative hemoglobin decrease,hospital stay,and stone free rate of the two groups were recorded. Results The stone size was（ 1. 0 ± 0. 3）cm in the URL group and（ 1. 4 ± 0. 4） cm in the PCNL group. The procedure was aborted in 1 case in the URL group due to stone moving up to the pelvis. The other 112 procedures were successful with stones completely removed. The operative time was（ 54. 0 ±24. 4） min in the URL group and（ 59. 4 ± 37. 0） min in the PCNL group. The perioperative hemoglobin decreased by（ 4. 3 ± 5. 7）g / L in the PCNL group and by（ 9. 5 ± 8. 0） g / L in the URL group. Postoperative fever（ T≥38 ℃） occurred in 4 patients in the URL group and in 6 patients in the PCNL group. The stone free rate was 98. 3%（ 59 /60） in the URL group and 100%（ 53 /53） in the PCNL group. The hospital stay was（ 6. 4 ± 2. 1） d in the URL group and（ 8. 5 ± 3. 4） d in the PCNL group. Conclusions Both URL and PCNL are effective and safe in the treatment of upper ureteral calculi. PCNL is applicable to patients with large stones,bearing high stone free rate but longer hospital stay.