上尿路结石211例治疗方法探讨

目的：评价上尿路结石不同治疗方法的疗效。方法：对采用5种不同治疗方法的211例上尿路结石患者的临床资料进行回顾性分析。结果：采用体外冲击波碎石术（ESWL）86例（41％），输尿管镜下气压弹道碎石术（URL）15例（7％），微创小切口开放手术15例（7％），开放手术辅助内镜取石术19例（9％），传统开放手术76例（36％）。ESWL治疗1个月后结石排净率为70％（60／86），2个月后结石排净率为77％（66／86），有3例发生输尿管石街，用URL或开放手术取净。URL对输尿管中下段结石取净率为100％，术中无输尿管穿孔、撕脱等并发症发生。微创小切口开放术结石取净率为87％，术中未输血。开放手术辅助内镜取石对肾结石的取净率为90％，术中未见肾皮质撕裂。传统开放手术结石取净率为86％，其中复杂性结石83％，术中术后输血7例（9％）。结论：上尿路结石可用腔内技术和ESWL治疗，微创小切口开放术、开放手术辅助内镜可提高复杂性结石的治愈率。

The management of upper urinary tract calculi ( report of 211 cases)

Objective: To evaluate the efficacy of different modalities in the management of upper urinary tract calculi.Method: The data of 211 cases of upper urinary tract calculi which were treated by 5 different treatment methods were analyzed retrospectively.Results: Among 211 cases 86cases(41%) were treated by extracorporeal lithotripsy(ESWL),15 cases(7%) by ureteroscopic lithotripsy(URL),15 cases(7%) by mini-incision open procedures,19 cases(9%) by endoscopy applicated open surgery,and 76 cases(36%) by traditional open surgery.The stone free rate after ESWL was 70%(60/86) at 1 month,77%(66/86) at 2 month.There were 3 stainstress after ESWL,and were rendered stone free with URL or open procedures.The stone free rate of URL was 100% for lower ureteral stones,There was no ureteral perforation and avulsion happened.The stone free rate of mini-incision open procedure was 87%,no transfusion required.90% stone free rate for endoscopy applicated open procedures,There was no avulsion of the renal cortex.The average stone free rate by traditional open surgery was 86%,and 83% for complicated cases,7 cases(9%) were required transfusion.Conclusion: Upper urinary tract calculi can be managed by endourologic techniques and ESWL,minimal incision procedures and open surgery combined with endoscopy,can improve the stone free rate of complicated upper tract calculi.