输尿管上段结石的三种处理方法及疗效分析

目的:探讨微创经皮肾镜碎石术(MPCNL)与经尿道输尿管镜碎石术(URL)以及体外冲击波碎石术(ESWL)治疗输尿管上段结石疗效。方法:对我院2006年3月至2011年7月收治的557例输尿管上段结石患者的临床资料进行回顾性分析,其中男318例,女239例;年龄18-74岁,平均年龄38.45±8.63岁。结果:各组手术时间有统计学差异(P=0.000),MPCNL组手术时间66.45±12.23 min最长,URL组35.60±8.96 min和ESWL组32.36±7.31 min较短,两组间无统计学差异(P=0.086);MPCNL术成功率97.79%(311/318),手术后1周内结石清除率88.42%(275/311),术后1-2个月复查结石清除率为97.10%(302/311);URL术成功率85.95%(153/178),URL手术后1周内结石清除率74.50%(114/153),术后1-2个月复查结石清除率为82.35%(126/153);ESWL术成功率83.72%(72/86),术后1周内结石清除率16.66%(12/72),术后1-2个月结石清除率为50.00%(36/72);术后血红蛋白下降值MPCNL显著高于其他两组(P=0.000,P=0.000),URL和ESWL无统计学差异(P=0.318)。结论:MPCNL治疗输尿管上段结石取石成功率高,结石残留率低,URL成功率较低,结石残留率高,ESWL创伤小,患者容易接受,但对于较大及复杂性结石疗效较差,MPCNL明显优于URL和ESWL,有条件医院应作为首选,对于位置偏低比较固定的输尿管上段结石可以考虑URL,对于单发结石(直径小于1.5cm),或多个小结石可以尝试ESWL。

Management and Efficacy Analysis of Upper Urinary Calculi with Three Methods

Objective: To study the effect of the minimally invasive percutaneous nephrolithotomy(MPCNL) in management of complicated upper ureteric calculi,comparing with transurethral ureteroscope lithotripsy(URL) and extracorporeal shock wave lithotripsy(ESWL).Method: 557 cases of patients of upper urinary tract calculi,collected from Jul.2006 to Jul.2011.Male 318 cases,female 239 cases;from the age 18 to 74,the average age was 38.45±8.63 years.Result: There were significantly difference on the operating time among the three groups(P=0.000),and the MPCNL group had the longest operating time(66.45±12.23 min),while the operating time group of URL group(28.45±8.96 min) and ESWL group(30.80±7.80 min) were shorter,and there were no significantly difference between the URL and ESWL group(P=0.086).The success rate of MPCNL was 97.79%,the stone clearance rate was 97.10%;The success of URL was 85.95%,the stone clearance rate was 82.35%;The success rate of ESWL was 83.72%,the stone clearance rate was 50.00%.The value of hemoglobin decrease in MPCNL group was significantly higher than the other two groups(P=0.000,P=0.000),and there were no significantly difference betweenthe URL and ESWL group(P=0.318).Conclusion: High stone-free rate can be obtained with minimally invasive percutaneous nephrolithotomy for complicated upper ureteric calculi.The stone-free rate was less effective with transur ethral ureteroscope lithotripsy.ESWL easily accepted by patients for its noninvasive,but for large and complex stone has poor treatment effect,As to skilled urologists in conditioned hospitals,MPCNL can be considered to be first choice for complicated upper ureteric calculi.As to lower and fixed position upper ureteric calculi,URL can be considered;ESWL can be considered to those stones diameter less than 1.5 centimeter or a multiple of small stones.