输尿管上段结石的微创治疗(附167例报告)

目的 探讨输尿管上段结石的微创治疗方法。方法 2001年1月～2004年7月间采用输尿管镜下气压弹道碎石(TUPL)，微创经皮肾穿刺取石术(mini-PCN)治疗输尿管上段结石167例。TUPL组101例。mini-PCN组66例。结果 TUPL组一次完全击碎或直接钳夹取出48例，37例需接受ESWL辅助治疗，5例穿孔，10例失败，15例改开放手术，1例仅留双J管。治疗成功率78．2％(79／101)。mini-PCN组一期穿刺取净结石56例，二期取净结石10例。结石清除率100％。结论 TUPL在治疗输尿管上段结石方面有损伤小的特点，但单用时结石清除率低，配合EWSL能取得满意的疗效。mini-PCN治疗上段输尿管结石清除率高，是治疗输尿管上段结石的理想方法。

Microtraumatic treatment of proximal ureteral calculus (report of 167 cases)

To explore the ideal way of mcrotraumatic treatment of proximal ureteral calculus. From January, 2001 to July, 2004, 167 cases of proximal ureteral calculus were treated by transureteroscopic pneumatic lithotripsy(TUPL) and minimal invasive percutaneous nephrolithotomy (mini-PCN). 101 cases were treated by transureteroscopic pneumatic lithotripsy(TUPL group), 66 cases were treated by minimal Invasive percutaneous nephrolithotomy (mini-PCN group). The stones of 48 cases in TUPL group were broken to pieces or taken out directly, but 37 cases in TUPL group need to be combined with ESWL; ureteral puncture occurred in 5 cases in TUPL group, and ureteroscope failed in 10 cases in TUPL group; 1 case was only incubated double J tube. The success rate was 78.2%. 56 cases were rendered stone-free at 1 session in mini-PCN group, and 10 cases were rendered stone-free at 2 sessions. The stone-free rate was 100 percent. Conclusions] TUPL has advantage of minimal trauma in treating proximal ureteral calculus, but the stone-free rate is less effective with transureteroscopic lithotripsy, it is effective transureteroscopic lithotripsy combined with ESWL. Minimal invasive percutaneous nephrolithotomy can obtain high stone-free rate, it is an ideal way of microtraumatic treatment of proximal ureteral calculus.