微创经皮肾镜和经尿道输尿管镜治疗输尿管上段结石的临床效果比较简

目的探讨微创经皮肾镜（MPCNL）和经尿道输尿管镜（URL）治疗输尿管上段结石的临床效果及安全性。方法选择2010年5月～2013年5月浙江省上虞市人民医院泌尿外科收治的输尿管上段结石的176例患者作为研究对象，将其随机分为MPCNL组和URL组，每组各88例。MPCNL组给予MPCNL治疗，URL组给予URL治疗，比较两组患者手术时间、术中出血量、住院时间、术后3d和术后1个月的结石清除率及并发症发生率。结果URL组的手术时间、术中出血量以及术后住院时间[（45．1±13．2）min、（68．7±25．2）mL、（5．9±1．7）d1均少于MPC—NL组【（79．2±22．4）min、（136．4±38．1）mL、（10．2±3．5）d1，差异有统计学意义（P〈0．05），然而术后3d和1个月的结石清除率（73．9％、89．8％）却低于MPCNL组（90．9％、100．0％），差异有统计学意义（P〈0．05）；两组各并发症发生率相比，差异均无统计学意义（均P〉0．05）。结论对于简单的输尿管上段结石，URL具有创伤小、出血少、手术时间和住院时间短的特点；而对于复杂性输尿管上段结石，MPCNL具有清除率高、安全、有效的优点，可作为治疗积水明显、结石过大或粘连包裹严重的复杂性输尿管上段结石的首选治疗方法。

Clinical effect comparison of minimally invasive percutaneous nephrolitho tomy and ureteroscopy lithotripsy for upper ureteral calculi

Objective To explore the clinical effects and safety of minimally invasive percutaneous nephrolithotomy （MPCNL） and ureteroscopy lithotripsy （URL） for upper ureteral calculi. Methods 176 patients with upper ureteral cal- culi from May 2010 to May 2013 in the Urology Department of the People＇s Hospital of Shangyu City were selected as study objects, and were randomly divided into MPCNL group and URL group, with 88 patients in each group. The pa- tients of MPCNL group were given MPCNL treatment and the patients of URL group were given URL treatment. The operation time, intraoperative blood loss, length of hospital stay, calculi clearance rate in 3 days and 1 month after, op- eration and incidence of complications of two groups were compared. Results The operative＂ time, intraoperative blood loss and length of hospital stay of URL group [（45.1_＋13.2） min, （68.7_＋25.2） mL, （5.9_＋l.7） d] were significantly~ less than those of MPCNL group [（79.2_＋22.4） min, （136.4_＋38.1） mL, （10.2_＋3.5） d], the differences were statistically signifi- cant （P 〈 0.05）. However, the calculi clearance rates of 3 days and 1 month after the operation of URL group （73.9%, 89.8%） were lower than those of URL group （90.9%, 100.0%）, the difference was statistically significant （P 〈 0.05）; there were no significant differences of the incidence of complications between the two groups （all P 〉 0.05）. Conclu- sion URL can be used for simple ulbper ureteral calculi for the less injury and intraoperative blood loss, shorter opera- tive time and length of hospital stay; while MPCNL can be the first choice for complicated upper ureteral calculi be- cause of the advantage of high calculi clearance rate, safety and efficacy.