微通道经皮肾镜治疗输尿管上段结石与输尿管硬镜碎石效果比较

Effect Comparison between Microchannel Percutaneous Nephrolithotomy and Transurethral Ureteral Lithotripsy in Treatment of Upper Ureteral Calculi

目的比较微通道经皮肾镜取石术(MPCNL)与经尿道输尿管镜碎石取石术(URL)治疗输尿管上段结石的临床效果及安全性。方法选取汉中市中心医院2014年5月—2016年1月收治的178例输尿管上段结石作为研究对象,其中行MPCNL治疗96例,行URL治疗82例,比较两组手术时间、术中出血量、住院时间、住院费用、中转开放手术、结石清除率以及并发症发生率。结果 MPCNL组手术时间、术中出血量、住院时间、住院费用均显著高于URL组(P<0.01);MPCNL组术后3 d、术后1个月的结石清除率均显著高于同期URL组(P<0.01);MPCNL组并发症发生率显著高于URL组(P<0.05);两组中转开放手术发生率比较差异无统计学意义(P>0.05)。结论 MPCNL与URL均是输尿管上段结石有效的微创治疗手段,对结石位置偏低、直径偏小的患者可考虑首选URL;对于嵌顿性输尿管上段结石以及结石位置较高的患者,MPCNL更为适用。

Objective To compare clinical efficacy and safety of microchannel percutaneous nephrolithotomy（MPCNL） and transurethral ureteral lithotripsy（URL） in treatment of upper ureteral calculi.Methods A total of 178 patients with upper ureteral calculi treated during May 2014 and January 2016 were recruited in this study,among whom96 patients were treated with MPCNL（MPCNL group） and 82 patients were treated with URL（URL group）.Operative time,intraoperative blood loss,length of stay,hospital costs,transit open surgery,clearance rate of calculi and incidence rate of complications were compared between two groups.Results Values of operative time,intraoperative blood loss,length of stay and hospital costs were significantly higher in MPCNL group than those in URL group（P〈0.01）.Clearance rates of calculi d and 1 month after operation in MPCNL group were significantly higher than those in URL group at the same periods（P〈0.01）.Incidence rate of complication in MPCNL group was significantly higher than that in URL group（P〈0.05）.There was no significant difference in incidence rate of transit open surgery between the two groups（P〉0.05）.Conclusion Both MPCNL and URL are effective methods of minimal invasion in treatment of upper ureteral calculi.URL can be the first choice for the lower location,small diameter of calculi of patients; while MPCNL is more suitable for patients with upper ureteral locking calculi with higher location.