微创经皮肾镜取石术治疗输尿管上段嵌顿性结石的临床观察

目的观察微创经皮肾镜取石术（MPCNL）治疗嵌顿性输尿管上段结石的疗效。方法回顾性分析单侧输尿管上段结石伴嵌顿患者115例,根据患者的选择分别采用MPCNL（65例）和经尿道输尿管镜取石术（URL）（50例）治疗,分别对其结石清除率、手术时间、住院时间、术中并发症发生率、术后辅助治疗、术后并发症等数据进行对比分析。结果 MPCNL组的术后3 d结石清除率为100.00%,而URL组的术后3 d结石清除率为62.00%,两组比较差异有统计学意义（P=0）。随访术后1个月的结石清除率,MPCNL组为100.00%,较URL组的84.00%明显提高（P=0.001）。MPCNL组的手术时间（t=5.753,P=0）和住院时间（t=8.635,P=0）较URL组的明显缩短。两组术中并发症、术后感染和血红蛋白下降发生率比较,差异无统计学意义（P〉0.05）。而MPCNL组术后辅助体外冲击波碎石术（ESWL）治疗率为1.54%,明显低于URL组的18.00%,差异有统计学意义（P=0.002）。结论 MPCNL治疗嵌顿性输尿管上段结石结石清除率高、并发症少、安全有效,可作为嵌顿性输尿管上段结石的首选治疗方法。

Clinical observation of minimally invasive percutaneous nephrolithotomy in the treatment of impacted upper ureteral stones

Objective To explore the effect of the minimally invasive percutaneous nephrolithotomy(MPCNL) in the treatment of impacted upper ureteral stones.Methods 115 cases of of impacted upper ureteral stones were studied retrospectively.According to the selection of operation,65 cases were underwent minimally invasive percutaneous nephrolithotomy lithotomy(MPCNL group) and 50 cases were underwent ureteroscopic lithotripsy(URL group).The stone-free rate,operative time,hospital stay,incidence of intraoperative complications,postoperative adjuvant therapy,postoperative complications and other data were analyzed.Results The stone-free rate at 3 days follow-up was 100.00% in MPCNL group,62.00% in URL group,the difference was statistically significant(P = 0).The stone-free rate at one month follow-up was 100.00% in MPCNL group and 84.00% in URL group(P = 0.001).In MPCNL group the operative time(t = 5.753,P = 0) and hospital stay(t = 8.635,P = 0) were significantly shorter than those in URL group.There were no significant differences in the rates of intraoperative complications,postoperative infection and hemoglobin decline between the two groups(P > 0.05).In MPCNL group,the rates of adjuvant ESWL was 1.54%,significantly lower than 18.00% in URL group(P = 0.002).Conclusion MPCNL for impacted upper ureteral calculi has a good stone-free rate,few complications,safe and effective,which can be the first choice.