6种微创方法治疗598例输尿管上段结石的疗效比较

Efficacy comparison of 6 different minimal invasive methods in the treatment of upper ureteric stone in 598 cases

目的:分析输尿管镜碎石术(URL)、输尿管软镜碎石术(fURL)、URL+N-Trap、体外冲击波碎石术(ESWL)、微创经皮肾镜取石术(m PCNL)和后腹腔镜下输尿管切开取石术(RLU)6种微创方法治疗输尿管上段结石的临床效果,以突出显示微创治疗输尿管上段结石的作用,为最佳微创治疗方法的选择提供参考。方法:对行URL 186例、f URL 39例,URL+N-Trap 149例、ESWL 131例,m PCNL 58例和RLU 35例输尿管上段结石病人的临床资料进行分析。结果:URL、f URL、URL+N-Trap、ESWL、m PCNL和RLU治疗输尿管上段结石碎石成功率分别为60.2%、92.3%、89.9%、93.9%、96.6%和97.1%。f URL、URL+N-Trap、ESWL、m PCNL和RLU对输尿管上段结石治疗成功率类似(P>0.05),均明显高于URL(60.2%)(P<0.01)。但URL、fURL、URL+N-Trap、不适合结石下方输尿管呈N形弯曲或进镜困难者。ESWL对≤10 mm结石病人一次成功碎石率高于>10 mm结石病人(P<0.01),但ESWL也不适合结石下方有息肉或狭窄者。结论:单用URL治疗输尿管上段结石碎石成功率低,可采用f URL或URL前预置N-Trap来提高碎石的成功率。各种微创手术治疗输尿管上段结石各有利弊,对微创方法治疗输尿管上段结石的选择应根据结石所在输尿管部位、结石大小、合并输尿管病变和具备输尿管镜辅助设备情况来决定。

Objective： To analyze the clinical effects of the urteroscopic lithotripsy（ URL）,flexible urteroscopic lithotripsy（ fURL）,URL combined with N-Trap,extracorporeal shock wave lithotripsy（ ESWL）,mini-percustaneous nephrolithotomy（ m PCNL） and retroperitoneal laparoscopic urterotomy（ RLU） in the treatment of upper ureteric stones for providing the reference in selecting the best treatment means of upper ureteric stones. Methods： The clinical data of 186 cases treated with URL,39 cases treated with f URL,149 cases treated with URL combined with N-Trap,131 cases treated with ESWL,58 cases treated with m PCNL and 35 cases treated with PLU were analyzed. Results： The success rates of URL,f URL,URL combined with N-Trap,ESWL,m PCNL and RLU in treating upper ureteric stones were 60. 2%,92. 3%,89. 9%,93. 9%,96. 6% and 97. 1%,respectively. The differences of the success rates of f URL,URL combined with N-Trap,ESWL,m PCNL and RLU in treating upper ureteric stones were not statistically significant（ P〉0. 05）,and which was significanly higher than that of URL（ P〈0. 01）. The URL,f URL and URL combined with N-Trap were not suitable for the patients with N-shape bending ureter or failure to access below ureteral calculi. The once success rate of ESWL in patients with stone diameter ≤10 mm was higher than that in patients with stone diameter 〉10 mm（ P〈0. 01）,and the ESWL was not suitable for patients with polyp or stricture below the ureteral calculi. Conclusions： The once success rate of single-use URL in treating upper ureteral calculi is low,and the f URL or URL combined with N-Trap can improve the success rate of lithotripsy. Selecting the minimal invasive method to treat upper ureteric stone should be based on the stone location,size,complicated with ureter diseases and ureteroscopy auxiliary equipment.