微创经皮肾镜取石术与输尿管镜钬激光碎石术治疗输尿管上段嵌顿结石合并感染的疗效对比

目的:对比微创经皮肾镜取石术(minimally invasive percutaneous nephrolithotomy,MPCNL)和输尿管镜钬激光碎石(ureteroscope lithotripsy,URL)治疗输尿管上段嵌顿结石合并感染的有效性和安全性。方法:收集输尿管上段嵌顿结石合并感染的患者共136例,随机分为观察组和对照组。观察组72例采用MPCNL治疗,对照组64例采用URL治疗,比较两种手术方式的结石清除率、手术时间、住院天数、术后并发症发生率等。结果:观察组术后3 d结石清除率为94.4%(68/72),显著高于对照组的79.7%(51/64)(P<0.05);术后30 d观察组结石清除率为100%(72/72),显著高于对照组的87.5%(56/64)(P<0.05);观察组手术时间与住院天数分别为(59.8±7.2)min与(7.02±2.3)d;对照组手术时间与住院天数分别为(47.2±6.9)min与(4.15±1.9)d,两组之间比较差异有统计学意义(P<0.05);两组术后并发症发生情况比较,差异无统计学意义(P>0.05)。结论:MPCNL的结石清除率高,但手术时间和住院天数较长;URL操作简单,恢复快,但疗效较差。临床医师应根据设备条件及病情选择合适的治疗方式。

Comparative study of MPCNL and URL for treatment of impacted upper ureter caculi combined with infection

Objective:To compare the effectiveness and safety of minimally invasive percutaneous nephrolithotomy(MPCNL) and ureteroscope Holmium laser lithotripsy (URL) in the treatment of impacted upper ureter caculi combined with infection.Methods:A total of 136 patients with impacted upper ureter caculi combined with infection were collected and randomly divided into observation group and control group.The observation group of 72 cases with MPCNL,control group of 64 cases were treated with URL,stone-free rate,operation time,hospitalization time,incidence of postoperative complications in the two groups were compared.Results:The stone-free rate of observation group was 94.4% (68/72),which was higher than 79.7% (51/64) in the control group 3 d after operation (P<0.05).The stone-free rate was 100% (72/72) in observation group, which was higher than 87.5% (56/64) in control group 30 d after operation (P<0.05).In observation group,the operative time (59.8±7.2) min and hospital stay (7.02±2.3) d,(47.2±6.9) min and (4.15±1.9) d in control group,there were significantly differences between the two groups (P<0.05).There was no significant difference in postoperative complications between the two groups (P>0.05).Conclusion:The stone-free rate of MPCNL is higher,but the operation time and length of hospital stay is longer,URL has advantages of simple operation and quick postoperative recovery,but it may have inferior efficacy.The clinical physicians should select a suitable method according to hospital equipment and the condition.