输尿管镜下与经皮肾镜钬激光碎石术治疗肾盂输尿管连接部结石的比较研究

Effect of ureteroscopic holmium laser lithotripsy versus percutaneous nephrolithotomy for the treatment of ureteropelvic junction stones

目的比较输尿管镜下钬激光碎石术与经皮肾镜钬激光碎石术治疗肾盂输尿管连接部(UPJ)结石的临床疗效及术后炎症反应。方法收集本院UPJ结石患者43例,根据手术方式分为经皮肾镜组(n=24)以及输尿管镜组(n=19)。对比2组的临床疗效及术后炎症状态。结果经皮肾镜组的远期清石率95.8%,显著高于对照组73.7%(P<0.05);与输尿管镜组相比,经皮肾镜组组患者碎石成功率较高、即刻清石率较高,但手术时间较长、术中出血量较多、导尿管留置时间较长、住院时间较长(P<0.05);与输尿管镜组相比,经皮肾镜组患者术后血尿持续时间较长,炎症反应综合征发生率较低(P<0.05)。结论两种术式对UPJ结石均有较好的治疗效果,但经皮肾镜碎石术治疗后的效果更好,远期清石率更高。

Objective To compare effect of ureteroscopic holmium laser lithotripsy versus percutaneous nephrolithotomy for the treatment of ureteropelvic junction（UPJ） stones.Methods Forty-three patients with UPJ stone in our hospital were divided into percutaneous nephrolithotomy group（n = 24） and ureteroscopy group（n = 19）.The clinical efficacy and postoperative inflammatory status were compared between the two groups.Results The long-term stone clearance rate of percutaneous nephrolithotomy group was higher than that of the ureteroscopy group（95.8% vs.73.7%,P〈0.05）.Compared with ureteroscopy group,percutaneous nephrolithotomy group had higher stone success rate and immediate stone removal rate; however,the operation time,intraoperative blood loss,indwelling time of catheter and length of stay in percutaneous nephrolithotomy group were longer than that in the ureteroscopy group.Furthermore,the duration of hematuria in the percutaneous nephrolithotomy group was longer,and the incidence rate of inflammatory reaction syndrome was lower compared with the ureteroscopy group.Conclusion Both therapies have a good therapeutic efficacy for the treatment of UPJ stones.The percutaneous nephrolithotomy has higher stone clearance rate and better curative efficacy.