输尿管镜与微创经皮肾镜治疗输尿管上段嵌顿性结石的比较

目的对比EMS碎石清石系统行输尿管镜与微创经皮肾镜治疗输尿管上段嵌顿性结石的疗效。 方法回顾性分析2014年1月至2016年12月中山大学附属第五医院收治的嵌顿性输尿管上段结石患者96例的临床资料，输尿管镜组与经皮肾镜组各48例。两组均采用EMS碎石清石系统，输尿管镜组使用输尿管硬镜取石术，经皮肾镜组使用微创经皮肾镜取石术。比较两组患者手术时间、术后住院时间、结石清除率及术后并发症等相关临床指标。 结果输尿管镜组手术时间和住院时间分别为（54±8）min和（3.6±0.7）d，经皮肾镜组分别为（59±9）min和（5.6±0.8）d，两组相比差异均有统计学意义（P<0.05）；经皮肾镜组一次碎石成功率为100.00%，高于输尿管镜组的75.00%，差异有统计学意义（P<0.05）；术后3 d清石率、1个月清石率输尿管镜组分别为47.92%和79.17%，经皮肾镜组分别为100%和100%，两组相比差异有统计学意义（P<0.05）。术中输尿管穿孔、输血率及术后发热、血尿等并发症发生率两组差异无统计学意义（P>0.05）。 结论对于嵌顿性输尿管上段结石，EMS碎石清石系统下行微创经皮肾镜比输尿管镜具有更高的结石清除率及手术成功率，是此类结石的有效治疗方法。

Comparison of ureteroscopic lithotripsy and minimally invasive percutaneous nephrolithotripsy in the treatment of impacted upper ureteral calculi

ObjectiveTo analyze the clinical effects and safety of ureteroscopic lithotripsy (URL) and minimally invasive percutaneous nephrolithotripsy (MPCNL) in the treatment of impacted upper ureteral calculi by using EMS system. MethodsNinety-six patients with impacted upper ureteral calculi were enrolled in the study from January 2014 to December 2016 in our hospital, and were divided into URL group and MPCNL group, with 48 patients in each group. The clinical effects and safety of the two groups were compared. ResultsThe operative time and the hospital stay in URL group were (54±8) min and (3.6±0.7)d, respectively, which were shorter than that in MPCNL group (59±9) min and (5.6±0.8) d, respectively (P<0.05). The success rate in MPCNL was 100%, while it was 75% in URL group (P<0.05). The stone clearance rate in the 3rd day and 1 month after URL operation were lower than that in MPCNL group (P<0.05). There was no significant difference in the incidence of ureteral perforation, blood transfusion, fever, and hematuria between the two groups (P>0.05). ConclusionMPCNL using EMS system is an efficacious and feasible approach for the treatment of impacted upper ureteral calculi due to the advantage of high calculi clearance rate, efficacy, and safety compared to URL.