微创经皮肾镜碎石与输尿管镜碎石术治疗嵌顿性输尿管上段结石的疗效比较

目的：比较微创经皮肾镜碎石术（minimally invasive percutaneous nephrolithotomy ，MPCNL）与输尿管镜碎石术（ ureteroscopic lithotripsy ，URL）治疗嵌顿性输尿管上段结石的疗效和安全性。方法回顾性分析2007年6月～2013年6月226例嵌顿性输尿管上段结石的临床资料，其中116例采用MPCNL治疗，110例采用URL治疗，比较两组结石清除率、手术时间、并发症发生率。结果 MPCNL组术后3 d结石清除率96．6％（112/116），1个月后的结石清除率为99．1％（115/116）。URL组术后3 d结石清除率为47．3％（52/110），49例残留结石＞0．4 cm，接受ESWL 治疗，1个月后结石清除率为83．6％（92/110）。结石清除率MPCNL组高于URL组（χ2＝68．873、17．619，P均＝0．000）。2组手术时间以及出血＞400 ml、发热和肾绞痛等并发症发生率差异无显著性（ P＞0．05）。结论 MPCNL治疗嵌顿性输尿管上段结石有很高的结石清除率；URL治疗效果稍差，而且需要结合ESWL治疗才能提高疗效。 MPCNL可作为嵌顿性输尿管上段结石的首选治疗方法。

Comparison of Minimally Invasive Percutaneous Nephrolithotomy and Transurethral Ureteroscopic Lithotripsy for Obstructive Upper Ureteral Calculus

Objective To compare the efficacy and safety of minimally invasive percutaneous nephrolithotomy （ MPCNL） with ureteroscopic lithotripsy （ URL） in the management of obstructive upper ureteral calculus . Methods Clinical data of 226 patients with ureteral calculus admitted into our hospital from June 2007 to June 2013 were retrospectively analyzed .Of them, 116 cases received MPCNL and 110 cases URL.The stone-free rate, operation time, postoperative complications were compared between the two groups, respectively. Results In the MPCNL group, the stone-free rate was 96.6%（112/116） in 3 days postoperation and 99.1%（115/116） in a month postoperation.In the URL group, the stone-free rate was 47.3% （52/110） in 3 days postoperation, with 49 patients having residual stones larger than 0.4 cm in diameter and thus receiving an EWSL .The stone-free rate was 83.6%（92/110） in a month postoperation in the URL group .The MPCNL group got a higher stone-free rate at both 3 days and 1 month postoperation compared with the URL group, with significant difference （χ2 =68.873 and 17.619, P =0.000）.No significant difference was detected in the operation time, rate of blood loss more than 400 ml, fever, renal colic between the two groups （P 〉0.05）. Conclusions Higher stone-free rate can be obtained with MPCNL than with URL for obstructive upper ureteral calculus .Performance of URL combined with auxiliary ESWL has satisfactory effects .The MPCNL should be the first choice for obstructive upper ureteral calculus.