体外冲击波碎石术和输尿管软镜治疗输尿管上段结石疗效比较

Curative effect of upper ureteral stones by extracorporeal shock wave lithotripsy vs. flexible ureteroscopy

目的:比较ESWL与输尿管软镜(FURL)治疗输尿管上段结石的临床疗效。方法:该研究选用输尿管上段结石患者95例,分为ESWL组54例及FURL组41例,对两种碎石取石方式进行疗效比较。结果:ESWL组一次碎石成功率(64.8%)明显低于FURL组一次碎石成功率(82.9%);两组术后并发症发生率无明显差异(P>0.05);但ESWL组手术时间及手术费用明显低于FURL组(P<0.05)。进一步根据结石直径分别将两组分为直径≤1.5cm组及直径>1.5cm组,发现结石直径≤1.5cm时ESWL组一次碎石成功率与FURL组一次碎石成功率差异无统计学意义(P>0.05);当结石直径>1.5cm时,两组一次碎石成功率差异有统计学意义(P<0.05)。结论:考虑到经济性、便捷性及安全性,对于直径小于1.5cm的输尿管上段结石,ESWL可以作为首选治疗方案;而对于直径1.5～2.0cm的输尿管上段结石,FURL明显优于ESWL。

Objective:To evaluate the curative effect of upper ureteral stones by extracorporeal shock wave lithotripsy vs.flexible ureteroscopy.Methods:Ninety-five patients with the upper ureteral stones were treated from January 2015 to January 2017,and divided into two groups(54 cases of extracorporeal shock wave lithotripsy and 41 cases of flexible ureteroscopy),and comparison was made between the two groups.Results:One-time successful rate of extracorporeal shock wave lithotripsy was 64.8%,which was significantly lower than that of flexible ureteroscopy(82.9%).There was no significant difference in the incidence of postoperative complications between the two groups.However,the operating time was longer and the expenses were greater in flexible ureteroscopy group than in extracorporeal shock wave lithotripsy group(P<0.05).Further,the two groups were compared according to the stone diameter(diameter of 1.5 cm or less and diameter more than 1.5 cm).No significant difference was found in one-time successful rate between the two groups when stone diameter was 1.5 cm or less.However,when stone diameter was more than 1.5 cm,there was significant difference in one-time successful rate between the two groups.Conclusions:Considering the cost,convenience and security,extracorporeal shock wave lithotripsy can be used as a preferred treatment in the upper ureteral stones with diameter of 1.5 cm or less.And flexible ureteroscopy was better than extracorporeal shock wave lithotripsy in the upper ureteral stones with diameter between 1.5 cm and 2.0 cm.