逆行输尿管镜和微创经皮肾输尿管镜治疗输尿管上段结石的临床观察

Clinical Observation of Ureteroscope and Mini- Percutaneous Nephrolithotripsy in the treatment of Upper Ureteral Calculi

目的：对比逆行输尿管镜和微创经皮肾输尿管镜治疗输尿管上段结石的临床疗效和安全性。方法：回顾分析2012年6月~2013年9月在我院诊断为输尿管上段结石,且经微创经皮肾输尿管镜（MPCNL）和逆行输尿管镜（URL）治疗的患者共82例,每组41例,比较两组患者的手术时间、手术出血量,术后住院天数、结石清除率,以及术后并发症。结果：82例患者均顺利完成手术,1个月后复查均无临床症状。URL组的平均手术时间明显较MPCNL组短,差异有统计学意义（P〈0.05）;术中出血量URL组较MPCNL组明显低,差异有统计学意义（P〈0.05）;术后住院时间MPCNL组高于URL组,差异有明显统计学意义（P〈0.05）;两组术后并发症比较,差异无统计学意义（P〉0.05）。术后1个月结石清除率比较,MPCNL组高于URL（P〈0.05）。结论：MPCNL和URL两种手术方法均可有效治疗输尿管上段结石。综合分析,临床中,应严格根据适应症选择合理的手术方式,结合患者自身个体差异,选择最佳方法,减小患者痛苦,提高治疗效果。

Objective Comparing the clinical efficacy and safety of ureteroscope （URL） and mini -percutaneous nephrolithotripsy （MPCNL） in the treatment of upper ureteral calculi. Method We had a retrospective analysis on 82 patients who in our hospital from June 2012 to September 2013 that were diagnosed with upper ureteral calculi, and took URL and MPCNL. Each group had 41 cases. Meanwhile, we compard two groups＇ operating time, bleeding volume, postoperative hospital stay, stone clearance rate, postoperative complications. Results 82 patients were successfully operated, there was no clinical symptoms a month later. The operating time of URL was significantly shorter than MPCNL, the difference was statistically significant （ P 〈 0. 05 ）. The bleeding volume of URL was significantly lower than MPCNL, the difference was statistically significant （ P 〈 0.05 ）. The postoperative hospital stay of URL was significantly lower than MPCNL, the difference was statistically significant （P 〈 0. 05 ）. There was no significant difference in postoperative complications between two groups. The stone clearance rate of URL was significantly lower than MPCNL, the difference was statistically significant （ P 〈 0. 05 ） . Conclusion The two of MPCNL and URL could be effective in the treatment of upper ureteral stones. But we have a comprehensive analysis in clinical, we should be strictly in accordance with indications and individual differences to take a reasonable surgical to reduce the suffering of patients, improve the effectiveness of treatment.