输尿管软镜钬激光碎石术与经皮肾镜钬激光碎石术治疗输尿管上段结石的疗效比较

Effect comparison of holmium laser lithotripsy and percutaneous holmium laser lithotripsy in the treatment of upper ureteral calculi

目的比较输尿管软镜钬激光碎石术(FURS)与经皮肾镜钬激光取石术(PCNL)治疗输尿管上段结石的临床疗效。方法选取2011年7月-2014年4月收治的结石直径6~10mm及行体外冲击波碎石术(ESWL)失败结石直径10~20mm的输尿管上段结石患者217例236侧。采用FURS 97例(104侧)作为FURS组,采用PCNL 120例(132侧)作为PCNL组。比较2组治疗结石的手术时间、碎石成功率、血红蛋白下降值、术后住院天数和并发症。结果 FURS组手术均顺利完成,术后发热8例(2.1%),未出现严重并发症。PCNL组手术均顺利完成,术后发热9例(7.5%),术中、术后明显出血3例,经选择性肾动脉栓塞治愈2例,经选择性肾动脉栓塞治无效,行患侧肾切除1例。FURS组手术时间长于PCNL组,血红蛋白下降值小于PCNL组,住院天数短于PCNL组,差异均有统计学意义(P<0.05);2组一期结石清除率比较差异无统计学意义(P>0.05)。结论对于结石直径6~10mm行ESWL失败及结石直径10~20mm的输尿管上段结石,FURS碎石与PCNL疗效相近,均为安全有效的治疗方法,但FURS取石术后患者恢复更快。

Objective To compare the efficiency of flexible ureteroscopy holminum laser( FURS) and percutaneous nephrolithotripsy holminum laser( PCNL) in treatment of proximal ureteral calculi. Methods Selected 217 cases of upper ureteral calculi 236 sides,including stone diameter 6 ~ 10 mm and the failure of the row ESWL stone diameter 10 ~ 20 mm,treated from July 2011 to April 2014. 97 cases( 104 sides) were treated by FURS( FURS group),120 cases( 132 sides) used PCNL( PCNL group). Compared the operation time,success rate of lithotripsy,hemoglobin decrease,postoperative hospital stay and complications of two groups. Results The operation of FURS group was successfully completed,postoperative fever in 8 cases( 2. 1%),no serious complications. The operation of PCNL group were successfully completed,postoperative fever in 9 cases( 7. 5%),intraoperative and postoperative bleeding in 3 cases,2 cases were cured by selective renal artery embolization,1 cases were treated by selective renal artery embolization,given with lateral nephrectomy. The operation time of FURS group was longer than PCNL group,decreased hemoglobin values was less than PCNL group,length of hospital stay was shorter than PCNL group,the differences were statistically significant( P < 0. 05); The stone clearance rate difference of two groups was not statistically significant( P > 0. 05). Conclusion For stone diameter 6mm to 10 mm ESWL failure and 10 mm to 20 mm diameter proximal ureteral calculi,FURS and PCNL have similar curative effect,can be selected,safe and effective treatment,the stones and FURS postoperative patients recover faster.