输尿管镜联合封堵器与斜卧截石联合体位微创经皮肾镜治疗输尿管上段嵌顿性结石比较

A comparative study of ureteroscopic lithotripsy combined with occlusion device and the supine and lithotomy position mini-invasive percutaneous nephrolithotomy for the treatment of upper incarcerated ureteral stones

目的比较输尿管镜联合封堵器与斜卧截石联合体位微创经皮肾镜治疗输尿管上段嵌顿性结石的临床治疗效果。方法回顾性分析2014年1月至2016年12月在我院住院行手术治疗的97例输尿管上段嵌顿性结石患者。随机分成两组:输尿管镜联合封堵器组,52例;微创经皮肾镜组,45例。两组间性别、年龄、结石大小无明显差异。结果微创经皮肾镜组和输尿管镜联合封堵器组的术中、术后各项指标分别为:手术时间(78.2±14.1)min vs.(53.3±12.4)min(P<0.05),手术成功率为97.8%vs.94.2%(P>0.05),结石清除率为100%vs.91.8%(P>0.05),并发症发生率为4.4%vs.3.9%(P>0.05),住院时间(9.1±3.2)d vs.(5.5±1.4)d(P<0.05)。所有患者均未出现感染性休克,无输尿管损伤、肠道损伤等并发症。结论输尿管镜联合封堵器和斜卧截石联合体位微创经皮肾镜均是治疗输尿管上段嵌顿性结石的安全、有效的手术方式。具体术式的选择须根据患者的病情特点和医生的手术经验等因素综合考虑。

Objective To compare the efficacy of ureteroscopic lithotripsy （URL） combined with occlusion device and the supine and lithotomy position mini-invasive percutaneous nephrolithotomy （mPCNL） in the treatment of upper incarcerated ureteral stones. No difference could be found in age, sex and size of stones between the two groups. Method From Jan. 2014 to Dec. 2016 in our hospital, all cases of upper incarcerated ureteral stones were diviede into two groups： 52 in ureteroscopic lithotripsy combined with occlusion device group and 45 in mini-inva- sive percutaneous nephrolithotomy group. Result The hospitalization and operation time in URL group were （5.5 -＋ 1.4） days and （53.3 -＋ 12.4） rains, which were significantly shorter than that in mPCNL group with （9.1 _＋ 3.2）days and （78.2 - 14.1 ）rains, （P 〈 0.05）. There were no differences between mPCNL and URL groups in the success rate of operation （97.8% vs 94.2%, P 〉 0.05） , stone clearance rate （100% vs 91.8, P 〉 0.05） and complication rate （4.4% vs 3.9%, P 〉 0.05）. Conclusion URL combined with occlusion device can obtain satifactory results as well as the supine and lithotomy position mPCNL in the treatment of upper incarcerated ureteral stones.