输尿管软镜与斜仰卧位微创经皮肾镜治疗输尿管上段结石的疗效比较

Comparison of flexible ureteroscopy and minimally invasive percutaneous nephrolithotomy in oblique supine position for proximal ureteral calculi

目的探讨输尿管软镜（FuRs）和斜仰卧位微创经皮肾镜（MP0儿）治疗输尿管上段结石的疗效。方法选取2010年6月至2014年2月铜川市人民医院收治的输尿管上段结石患者192例，随机分为FURS组98例和MPCNL组94例，结石直径10～20mm，均为单发。两组患者年龄、性别、结石直径、肾积水程度、体外冲击波碎石（ESWL）无效比例等比较差异无统计学意义（P〉0．05）。观察指标包括手术时间、术后住院时间、清石率、术中出血〉400ml例数、术中转开放手术例数、并发症发生率及术后发热例数，并分析结石成份。结果FURS组和MPCNL组手术时间分别为（65．7±16．8）min和（48．9±12．1）min，术后住院时间分别为（1．8±0．8）d和（4．6±1.3）d，两组间差异比较均具有统计学意义（P〈0．01）：FURS组和MPCNL组患者结石清除率分别为84．6％和94．7％，并发症（Clavien分级II级）发生率分别为9．2％和14．8％，差异均无统计学意义（P〉0．05）；此外，中转开放手术、出血〉400ml及术后发热例数两组间比较差异均无统计学意义（P〉0．05）；结石成份分析显示，草酸钙结石所占比例最大，为51．6％（99／192）。结论FURS和斜仰卧位MPCNL治疗输尿管上段结石都是安全有效的方法，斜仰卧位MPCNL手术时间短，FURS取石术后患者恢复快。

ObijectiveTo compare the safety and clinical efficacy between flexible ureteroscopy（FURS） and minimally invasive percutaneous nephrolithotomy （MPCNL） in oblique supine position inmanagement of proximal ureteral calculi.methods From June 2010 to February 2014, 192 patients withsingle proximal ureteral calculus between 10-20 mm failed in extracorporeal shock wave lithotripsy or other conservative therapies accepted FURS （98 cases） or MPCNL （94 cases） randomly in the People＇s Hospital of Tongchuan City. There were no significant differences between the groups in base-line parameters. Operative duration, postoperative hospital stay, intraoperative blood loss, complication rates （Clavien degree II or over）, stone-free rates, postoperative fever and the rates of conversion to open surgery were comparedretrospectively.Resuit The operative duration time of FURS group and MPCNL group were （65.7±16.8）min and 08.9±12.1） min （P〈0.01）, postoperative hospitalization stay were （1.8＋0.8） days and 0.6±1.3） days （P〈0.01）, stone free rates （residual fragments≤3 mm） were 84.6% and 94.7% （P〉0.05） and complication rates were 9.2% and 14.8% （P-A）.05）, respectively. There were no significant differences between the groups in intraoperative blood loss （the volume ≥400 ml）, postoperative fever and the rates of conversion to open surgery （~0.05）. Stone composition analysis showed that the proportion of calcium oxalate stone was 51.6%（99/192）.ConclusionFor patients with surgically indicated proximal ureteral calculi, both minimallyinvasive percutaneous nephrolithotomy in oblique supine position and flexible ureteroscopy are effective andsafe therapeutic modalities. Patients treated with minimally invasive percutaneous nephrolithotomy in oblique supine position have shorter operative time, and patients treated with flexible ureteroscopy have faster postoperative recovery.