经皮肾镜取石术与输尿管镜碎石术治疗上段嵌顿性输尿管结石的效果对比

Effect comparison of percutaneous nephrolithotomy and ureteroscopic lithotripsy in the treatment of impacted upper ureteral calculi

目的比较经皮肾镜取石术与输尿管镜碎石术治疗上段嵌顿性输尿管结石的效果。方法分析我院2013年3月~2017年3月泌尿外科收治的上段嵌顿性输尿管结石180例患者的临床资料,依据治疗措施不同进行分组,经皮肾镜取石术组90例和输尿管镜碎石术组90例。观察两组患者的手术时间、术中出血量、住院时间、肾积水缓解率、残石率、血尿并肾绞痛、输尿管穿孔发生率情况。结果输尿管镜碎石术组患者的手术时间、住院时间均短于经皮肾镜取石术组,术中出血量少于经皮肾镜取石术组,肾积水缓解率低于经皮肾镜取石术组,差异有统计学意义(P<0.05)。两组患者的残石率、血尿并肾绞痛、输尿管穿孔发生率差异均无统计学意义(P>0.05)。结论输尿管镜碎石术治疗上段嵌顿性输尿管结石手术时间短、创伤小,但是其肾积水缓解率低于经皮肾镜取石术,应针对患者的临床特点,选择有效的手术措施。

Objective To compare the effect of percutaneous nephrolithotomy and ureteroscopic lithotripsy in the treat- ment of impacted upper ureteral calculi.Methods Clinical data of 180 patients with impacted upper ureteral calculi treated in urology department of Quanzhou Southeast Hospital from March 2013 to March 2017 was analyzed.According to different treatment measures,90 cases were treated with percutaneous nephrolithotomy （percutaneous nephrolithotomy group） and 90 cases were treated with ureteroscopic lithotripsy （ureteroscopic lithotripsy group）.The operation time, blood loss during operation,hospital stay,hydronephrosis remission rate,residual stone rate,the incidence of hematuria combined with renal colic and ureteral perforation in patients of the two groups were observed.Results The operation time,hospital stay in the ureteroscopic lithotripsy group were shorter than those of percutaneous nephrolithotomy group, blood loss during operation was fewer than that of percutaneous nephrolithotomy group,hydronephrosis remission rate in ureteroscopic lithotripsy group was lower than that in percutaneousnephrolithotomy group,and the difference was statis- tically significant （P〈0.05）.There was no significant difference in residual stone rate,the incidence of hematuria com- bined with renal colic and ureteral perforation between the two groups （P〉0.05）.Conclusion Ureteroscopic lithotripsy for the treatment of impacted upper ureteral calculi with shorter operation time,less trauma,but has lower hydronephro- sis remission rate than percutaneous nephrolithotomy.So,it should select effective surgical measures according to the clinical characteristics of the patients.