MPCNL与URL治疗输尿管上段结石梗阻合并感染的对比研究

Comparative study between MPCNL and URL on the treatment of obstructive upper ureteral calculus combined with infection

目的:对比研究微创经皮肾镜取石术(MPCNL)与经输尿管镜钬激光取石术(URL)治疗输尿管上段结石梗阻合并感染的有效性与安全性。方法:回顾性分析2010年6月～2016年12月于我院接受手术治疗的输尿管上段结石患者,共纳入180例,随机分为MPCNL组97例和URL组83例。收集所有符合纳入标准患者的性别、年龄、结石大小、结石清除率、手术时间、术后住院时间、术后并发症并进行比较分析。结果:两组患者在性别、年龄及结石大小方面比较差异无统计学意义(P>0.05);MPCNL组术后一期结石清除率为97.9%(95/97),URL组术后一期结石清除率为89.2%(74/83),两组比较差异有统计学意义(P=0.014);MPCNL组和URL组平均手术时间分别为(35.37±5.62)min和(37.24±6.15)min,两组比较差异无统计学意义(P=0.198);MPCNL组和URL组平均术后住院时间分别为(5.29±0.69)d和(2.43±0.63)d,两组比较差异有统计学意义(P<0.001)。MPCNL组并发症总发生率为27.8%(27/97),术后感染发生率为6.2%(6/97),均显著低于URL组的51.8%(43/87)和15.7%(13/87),差异均有统计学意义(P=0.001,P=0.038)。结论:输尿管上段结石梗阻并感染的手术治疗选择MPCNL可能更安全、有效。

Objective:To evaluate the safety and efficacy of patients with obstructive upper ureteral calculus combined with renal intrarenal infection treated by minimally percutaneous nephrolithotomy(MPCNL)and ureteroscopic lithotripsy(URL)with holmium laser.Method:A total of 180 cases according to the inclusion criteria in the Urology department of our hospital from June 2010 to December 2016 were retrospectively reviewed,and they were randomly divided into MPCNL group and URL group.The clinical data including gender,age,stone size,the success rate,operating time,postoperative hospitalization duration and complications between the two groups were compared.Result:There was no significant difference between the two groups in terms of gender,age,stone size(P>0.05).The success rate of MPCNL group was 97.9%(95/97)compared with 89.2%(74/83)of URL group after one week of the operation(P=0.014).The operation time between the two groups has no statistical significance,(35.37±5.62)min for MPCNL group and(37.24±6.15)min for URL group(P=0.198).The mean postoperative duration was(5.29±0.69)d for MPCNL group and(2.43±0.63)d for URL group(P<0.001).The total complications and the incidence of postoperative infection was significantly higher in URL group 51.8%(43/87)and 15.7%(13/87)versus 27.8%(27/97)and 6.2%(6/97)in MPCNL group(P=0.001,P=0.038,respectively).Conclusion:MPCNL might be the first choice for patients with obstructive upper ureteral calculus combined with renal intrarenal infection for its higher success rate and lower complications.