URL联合ESWL VS PCNL治疗1～2cm输尿管上段结石的对比研究

URL Combined with ESWL VS PCNL in the Treatment of Upper Ureteral Calculi 1～2 cm in Diameter: A Comparative Study

目的 探讨经尿道输尿管镜下碎石术（Ureteroscope lithotripsy,URL）联合体外冲击波碎石术（Extracorporeal shock wave lithotripsy,ESWL）与经皮肾镜取石术（Percutaneous nephrolithotomy,PCNL）治疗输尿管上段结石的临床疗效.方法 整群选择2012年7月—2015年8月该院收治的65例1~2 cm输尿管上段结石患者,按治疗方式分为联合组（n=35）和PCNL组（n=30）,对其临床疗效进行回顾性分析.结果 联合组与PCNL组术后3个月结石清除率、术后并发症发生率分别为94.28%VS96.67%（P〉0.05）、5.72%VS 13.33%（P〉0.05）联合组手术时间、术中出血量显著低于PCNL组（P〈0.05）.结论 URL联合ESWL治疗1~2 cm输尿管上段结石清除率与经皮肾取石相当,且可缩短手术时间,降低术中出血量和术后并发症发生率适合基层医院推广.

Objective To investigate the clinical effect of ureteroscope lithotripsy （URL） combined with extracorporeal shock wave lithotripsy （ESWL） versus percutaneous nephrolithotomy （PCNL） in the treatment of upper ureteral calculi 1-2 em in diameter. Methods From July 2012 to August 2015, 65 cases with upper ureteral calculi 1-2 cm in diameter admitted in our hospital were selected and divided into the combined group （n=35） and PCNL group （n=30） according to the treatment regimen. And the clinical therapeutic effect was analyzed retrospectively. Results The difference in the stone clearance rate between the combined group and the PCNL group （94.28% vs 96.67%） 3 months after surgery was not statistically signifi- cant （P〉0.05）. The difference in the incidence of postoperative complications between the combined group and the PCNL group （5.72% vs 13.33%） was not statistically significant （P〉0.05）. Compared with the PCNL group, the combined group had much shorter duration of procedure and obviously less intraoperative blood loss （P〈0.05）. Conclusion URL combined with ESWL has the same effect as PCNL in the treatment of upper ureteral calculi 1 ~2 cm in diameter, but with shorter duration of procedure and less intraoperative blood loss and lower incidence of postoperative complications, so it is suitable for further popularization and application in primary-level hospitals.