微创经皮肾镜取石术和经尿道输尿管镜取石术治疗幼儿输尿管中上段结石的疗效和安全性研究

The curative effect and safety of microinvasive percutaneous nephrolithotomy and ureteroscope lithotripsy in treatment of children＆#39; s middle and upper segment ureteral calculi

目的：探讨微创经皮肾镜取石术（MPCNL）和经尿道输尿管镜取石术（URSL）治疗≤6岁输尿管中上段结石患儿的临床疗效和安全性。方法选取≤6岁输尿管中上段结石患儿80例，按照随机数字表法分为观察组和对照组，每组40例。观察组采用MPCNL治疗，对照组采用URSL治疗。比较两组手术时间、住院时间、一期结石取净率、术后血红蛋白和红细胞压积下降情况及并发症发生情况。结果观察组手术时间和住院时间明显短于对照组[（45.43±9.76）min比（68.32±11.28）min 和（8.12±1.03）d 比（13.45±2.34）d]，一期结石取净率明显高于对照组[100.0%（40/40）比62.5%（25/40）]，并发症发生率明显低于对照组[20.0%（8/40）比60.0%（24/40）]，差异有统计学意义（P＜0.05）；两组术后血红蛋白和红细胞压积下降比较差异无统计学意义（P＞0.05）。结论 MPCNL治疗幼儿输尿管中上段结石手术时间短，一期结石取净率高，围手术期并发症发生率低，较URSL安全高效，值得临床推广应用。

Objective To investigate the curative effect and safety of microinvasive percutaneous nephrolithotomy （MPCNL） and ureteroscope lithotripsy （URSL） in treatment of children′s （≤6 years old） middle and upper segment ureteral calculi. Methods Eighty children （≤6 years old） with middle and upper segment ureteral calculi were selected, and they were divided into observation group and control group according to random number table method with 40 cases each. The children of observation group were treated with MPCNL, and the children of control group were treated with URSL. The operation time, hospitalization time, calculi clearance rate of the first phase, decline situation of the postoperative hemoglobin and hematocrit and complication were compared between 2 groups. Results The operation time and hospitalization time in observation group were significantly shorter than those in control group：（45.43 ± 9.76） min vs. （68.32 ± 11.28） min and （8.12 ± 1.03） d vs. （13.45 ± 2.34） d, the calculi clearance rate of the first phase was significantly higher than that in control group： 100.0% （40/40） vs. 62.5%（25/40）, the incidence of complication was significantly lower than that in control group：20.0%（8/40） vs. 60.0% （24/40）, and there were statistical differences （P〈0.05）. There were no statistical differences in the decline situation of the postoperative hemoglobin and hematocrit between 2 groups （P〉0.05）. Conclusions The MPCNL in treatment of children′s middle and upper segment ureteral calculi has short operation time, high calculi clearance rate of the first phase, and low incidence of perioperative complication. Compared with URSL, the URSL is safe and efficient, and it is worthy of clinical＆amp;nbsp;application.