术中输尿管上段结石移位后同期两种手术治疗方式比较

Comparison of two surgical treatments for upper ureteral calculi after translocation during the same period

目的探讨提高输尿管上段结石治疗效果的方法。方法回顾性分析2012年7月至2017年5月我科收治的68例输尿管上段结石移位患者的临床资料,所有68例患者均在全麻下行输尿管硬镜碎石治疗,术中出现结石移位,同期行微创经皮肾镜碎石取石术(MPCNL)32例、经尿道输尿管软镜手术(RIRS)36例,对两种术式治疗效果及并发症进行分析。结果 32例行MPCNL,碎石成功率93.8%,36例行RIRS,碎石成功率100%。RIRS组恢复快,住院时间短。无输血、输尿管穿孔等,随访3～6个月,未出现大出血、输尿管狭窄等严重并发症。结论输尿管硬镜碎石治疗输尿管上段结石移位至肾脏后,同期RIRS可作为输尿管上段结石的治疗首选。

Objective To explore the method of improving the clinical efficacy in the treatment of upper ureteral calculi.Methods Clinical data of 68 patients with upper ureteral calculus and translocation during surgery admitted to our department from July,2012 to May,2017 were retrospectively analyzed.All 68 patients were treated with ureteroscopic lithotripsy under general anesthesia,and calculus displacement occurred during the operation.Thirty-two patients underwent minimally invasive percutaneous nephrolithotomy(MPCNL)and 36 patients were treated with retrograde intra-renal surgery(RIRS).The clinical efficacy and postoperative complications were analyzed.Results A total of 32 cases were treated with MPCNL and the success rate of lithotripsy was 93.8%.Thirty-six patients underwent RIRS and the success rate of lithotripsy was 100%.Patients in the RIRS group obtained faster postoperative recovery and shorter length of hospital stay than their counterparts in the MPCNL group.No blood transfusion,ureteral perforation,or other severe complications such as massive hemorrhage and ureteral stricture occurred during postoperative follow-up for 3-6 months.Conclusions RIRS can be the primary treatment of the upper ureteral calculi migrating to the kidney during ureteroscopic lithotripsy.