微创经皮肾镜取石术与输尿管镜下碎石术治疗输尿管上段嵌顿性结石的疗效比较

Comparison of minimally invasive percutaneous nephrolithotomy and ureteroscopic lithotripsy in the treatment of impacted upper ureteral calculi

目的比较微创经皮肾镜取石术(mPCNL)与输尿管镜下碎石术(URL)治疗输尿管上段嵌顿性结石中的疗效及安全性。方法回顾性分析2017年1月至2019年2月在本院收治的85例输尿管上段嵌顿性结石患者的临床资料。38例患者采用mPCNL术(mPCNL组),47例患者采用URL术(URL组),比较两组患者的手术时间、术后住院时间、并发症发生率、术后3~5 d的结石清除率、术后30 d的结石清除率情况。结果mPCNL组手术时间、术后住院时间明显大于URL组,差异有统计学意义(P<0.05)。手术效果方面,mPCNL组术后3~5 d结石清除率[100%(38/38)]明显高于URL组[85.1%(40/47)],术后1个月mPCNL组结石清除率[100%(38/38)]明显高于URL组[93.6%(44/47)],差异有统计学意义(P<0.05)。术后并发症方面,mPCNL组总并发症发生率为13.2%(5/38)、URL组为12.8%(6/47),差异无统计学意义(P>0.05)。结论mPCNL与URL对输尿管上段嵌顿性结石均具有良好疗效,而mPCNL在不明显增加手术并发症的基础上具有更好的结石清除率,可作为一种常规方法。

Objective To compare the efficacy and safety of minimally invasive percutaneous nephrolithotomy(mPCNL)and ureteroscopic lithotripsy(URL)in the treatment of impacted upper ureteral calculi.Methods A retrospective analysis was made on the diagnosis and treatment of 85 cases of upper ureteral impacted calculi from January 2017 to February 2019.There were 38 cases treated by the mPCNL while 47 patients URL.The differences including operation time,hospitalization time,complication rate,stone clearance rate 3-5 days after operation and 30 days after operation between two methods were compared.Results The operation time and hospitalization time of mPCNL were significantly longer than those of URL(P<0.05).The stone clearance rate of mPCNL was 100%,which was higher than that of URL after 3-5 days operation.Meanwhile,The stone clearance rate of mPCNL after 1 month operation(100%)was also significantly higher than that of control group(93.6%).The difference was statistically significant(P<0.05).For postoperative complications,the total incidence of complications in mPCNL group was 13.2%while 12.6%for URL,there was no significant difference between the two methods.Conclusions Both of the two methods have good curative effect on upper ureteral incarcerated calculi.The mPCNL has better stone clearance rate with no significant increase in operative complications,and can be used as a routine method.