输尿管硬镜联合软镜碎石术与微创经皮肾镜取石术处理输尿管上段嵌顿结石的比较

Comparison Between Rigid Combined with Flexible Ureteroscopic Lithotripsy and Minimally Invasive Percutaneous Nephrolithotomy for Impacted Upper Ureteral Calculi

目的比较输尿管硬镜联合软镜碎石术与微创经皮肾镜取石术(minimally invasive percutaneous nephrolithotomy,MPCNL)治疗嵌顿性输尿管上段结石的有效性及安全性。方法回顾性分析2010年6月~2015年4月我院102例嵌顿性输尿管上段结石的临床资料,根据治疗方法分为2组,双镜联合治疗54例(双镜联合组),MPCNL治疗48例(MPCNL组),比较2组手术时间、术中出血量、术后住院时间、结石清除率及手术并发症。结果所有患者均耐受手术,无严重并发症发生。双镜联合组手术时间(87.9±21.6)min,显著长于MPCNL组(61.5±16.7)min(t=-6.795,P=0.000)。MPCNL组术中出血量(52.8±9.6)ml,显著多于双镜联合组(12.5±2.6)ml(t=29.644,P=0.000)。MPCNL组术后住院时间(6.1±1.3)d,明显长于双镜联合组(2.8±0.7)d(t=16.162,P=0.000)。术后并发症发生率2组差异无显著性(χ~2=0.330,P=0.566)。术后1个月结石清除率MPCNL组为95.7%(45/47),双镜联合组为94.4%(51/54),2组差异无显著性(χ2=0.000,P=1.000)。结论输尿管硬镜联合软镜碎石术与MPCNL治疗嵌顿性输尿管上段结石均具有满意的疗效与安全性,双镜联合碎石术利用人体自然腔道进行微创操作,不存在对肾实质的直接损伤,具有出血少、创伤小、住院时间短等特点。

Objective To compare the efficacy and safety between rigid combined with flexible ureteroscopic lithotripsy and minimally invasive percutaneous nephrolithotomy（MPCNL） for impacted upper ureteral calculi. Methods We retrospectively analyzed 102 cases of impacted upper ureteral calculi treated in our hospital between June 2010 and April 2015. The patients were divided into two groups according to treatment methods： 54 cases underwent rigid combined with flexible ureteroscopic lithotripsy（Combined group） and 48 cases received MPCNL（MPCNL group）. The operation time,blood loss during operation,clearance rate of the stone,incidence of postoperative complications,and hospitalization time were statistically analyzed. Results All the patients tolerated operations without severe complications. The mean operation time of the Combined group was（87. 9 ± 21. 6） min,which was significantly longer than that of the MPCNL group [（61. 5 ± 16. 7） min,t =-6. 795,P = 0. 000]. The intraoperative blood loss in the MPCNL group was（52. 8 ± 9. 6） ml,which was higher than that of the Combined group [（12. 5 ± 2. 6） ml,t = 29. 644,P =0. 000]. The mean postoperative hospitalization time in the MPCNL group was（6. 1 ± 1. 3） d,which was longer than that in the Combined group [（2. 8 ± 0. 7） d,t = 16. 162,P = 0. 000]. There was no significant difference in the incidence of postoperative complications between the two groups（χ^2= 0. 330,P = 0. 566）. The stone clearance rates after one month postoperation were 95. 7%（45/47） and 94. 4%（51/54） in the MPCNL group and Combined group,but there was no signification difference between the two groups（χ^2= 0. 000,P = 1. 000）. Conclusions Both rigid combined with flexible ureteroscopic lithotripsy and MPCNL are effective and safe for impacted upper ureteral calculi. Rigid combined with flexible ureteroscopic lithotripsy is a kind of natural orificetransluminal endoscopic surgery,which has no direct damage to the renal parenchyma with less bleeding and trauma,and shorter hospitalization time.