微创经皮肾镜取石和经尿道输尿管镜碎石治疗输尿管上段嵌顿性结石的疗效比较

目的比较微创经皮肾镜穿刺取石术（minimally invasive precutaneous nephrolithotomy,MPCNL）与经尿道输尿管镜碎石术（transurethral ureteroscopic lithotripsy,URL）治疗输尿管上段嵌顿结石的疗效。方法从2008年03月～2012年03月,70例单侧嵌顿性输尿管上段结石的患者,35例采用MPCNL治疗,35例采用URL治疗,对2组患者的结石清除率、手术时间、术中出血、住院时间以及手术并发症等进行分析比较。结果 MPCNL组术后3d结石清除率为97.14%（34/35）,术后1个月结石清除率为100%（35/35）;URL组术后3d结石清除率为25.71%（9/35）,术后1个月的结石清除率为82.86%（29/35）,均显著低于MPCNL组（P〈0.05）;在手术时间、术中出血、住院时间、术后发热（T〉38.5℃）的发生率等方面,MPCNL组和URL组在统计学上无显著性差异（P〉0.05）。结论 MPCNL治疗输尿管上段嵌顿性结石相较URL,其结石清除率高,且具有安全、有效、术后并发症少等的优点,可作为输尿管上段嵌顿性结石的首选治疗方法。

Comparison of minimally invasive percutaneous nephrolithotomy and transurethral ureteroscopic lithotripsy for impacted upper ureteric calculi

Objective To compare the efficacy of minimally invasive percutaneous nephrolithotomy（MPCNL） and transurethral ureteroscopic lithotripsy（URL） for impacted upper ureteric calculi.Methods A total of 70 cases were diagnosed as unilateral impacted upper urteric calculi during March,2008 to March,2012,of which 35 received transurethral URL and the other 35 received MPCNL.The stone-free rate,operation time,intraoperative blood loss,hospital stay and complications were statistically analyzed.Results In the MPCNL group,the stone-free rate was 97.14%（34/35） 3 days after operation and 100%（35/35） 1 month after operation.In the URL group,the stone-free rate was 25.71%（9/35） 3 days after operation and 82.86%（29/35） 1 month after operation.The MPCNL group had higher stone-free rates（P0.05）.There were no statistical difference between the two groups in operation time,intraoperative blood loss,hospital stay and the incidence of postoperative hyperpyrexia（T38.5℃,P0.05）.Conclusion As compared with the URL,MPCNL is more effective and can be the first choice for impacted upper ureteric calculi.