两种术式治疗体外冲击波碎石术失败输尿管上段嵌顿性结石的临床疗效

Clinical comparative study of two kinds of surgical methods in the treatment of incarcerated upper ureteral calculi with failed in ESWL lithotripsy

目的探讨输尿管硬镜碎石术与经皮肾镜取石术治疗体外冲击波碎石术(ESWL)碎石失败输尿管上段嵌顿性结石临床疗效及安全性差异。方法研究对象选取平顶山煤业集团总医院2012年6月至2014年6月收治ESWL碎石失败输尿管上段嵌顿性结石共80例,采用随机区组法分为A组(40例)和B组(40例),分别行输尿管硬镜碎石术与经皮肾镜取石术治疗;比较两组患者围手术期临床指标水平、手术成功率,随访结石清除率及术后并发症发生率等。结果两组患者手术时间比较差异无统计学意义(P>0.05);A组患者血红蛋白下降量[(5.33±1.10)g/L]、术后输血率(2.50%)及住院时间[(4.52±0.98)d]均显著优于B组[(11.45±2.27)g/L、7.50%、(7.33±1.62)d],差异有统计学意义(P<0.05);B组患者手术成功率(97.50%)和随访结石清除率(100%)均显著高于A组(77.50%、85.00%),差异有统计学意义(P<0.05);两组患者术后发热率比较差异无统计学意义(P>0.05);B组患者术后严重血尿发生率(10.00%)显著高于A组(2.5%),差异有统计学意义(P<0.05)。结论相较于输尿管硬镜碎石术,经皮肾镜取石术治疗ESWL碎石失败输尿管上段嵌顿性结石可有效改善手术治疗效果,提高结石清除率,且并未导致严重并发症出现。

Objective To investigate the clinical effects and safety differences of two kinds of surgical methods in the treatment of incarcerated upper ureteral calculi with failed in ESWL lithotripsy including ureteral lithotripsy and percutaneous nephrolithotomy. Methods 80 patients with incarcerated upper ureteral calculi with failed in ESWL lithotripsy were chosen in the period from June 2012 to June 2014 in our hospital and randomly divided into both group including A group(40 patients) with ureteral lithotripsy and B group(40 patients) with percutaneous nephrolithotomy; and the perioperative clinical indicators, the success rate of operation, the stone clearance rate with follow-up and postoperative complications incidence of both groups were compared. Results There was no significant difference in operation time between 2 groups(P>0.05). The hemoglobin decline amount, postoperative blood transfusion rate and hospitalization time of A group was significantly better than B group(P<0.05). The success rate of operation and the stone clearance rate with follow-up of B group was significantly higher than A group(P<0.05). There was no significant difference in fever after operation incidence between 2 groups(P>0.05). The postoperative severe hematuria incidence of B group was significantly higher than A group(P<0.05). Conclusions Compared with ureteral lithotripsy, percutaneous nephrolithotomy in the treatment of incarcerated upper ureteral calculi with failed in ESWL lithotripsy can efficiently improve the surgical treatment effects, increase the stone clearance rate and not cause the serious complications occurrence.