第4、5腰椎水平输尿管结石三种手术方法的比较

目的探讨第4、5腰椎水平输尿管结石的治疗方法。方法回顾性分析应用微创经皮肾镜取石术（MPCNL）、经尿道输尿管镜下气压弹道／钬激光碎石术（URL）、经皮肾穿刺造瘘联合经尿道输尿管镜碎石治疗的第4、5腰椎水平的输尿管结石320例患者资料，对比三种方法的疗效。结果208例行MPCNL术，一次清石率96．6％；92例行URL术，一次清石率90．2％，残留结石均经辅助治疗后全部排出；20例行经皮肾穿刺造瘘联合经尿道输尿管镜碎石术，一次清石率100％，随访1～28个月，未出现严重并发症。结论MPCNL术已成为治疗第4、5腰椎水平输尿管结石的主要方法，URL术不作为首选方法，部分难治性病例可考虑应用经皮肾穿刺造瘘联合经尿道输尿管镜碎石术。

Comparative study of three means of treatment for ureteral calculi between the fourth and fifth lumbar vertebrae

Objective To explore the minimally invasive means for the treatment of ureteral calculi between the fourth and fifith lumbar vertebrae. Methods The clinical data of 320 cases were analyzed retrospectively. The cases were treated with minimally invasive percutaneous nephrolithotomy （MPCNL）, transurethral ureteroscopic pneumatic or holmium laser lithotripsy（URL） ,and combination of percutaneous nephrostomy and transurethral ureteroscopic lithotripsy. The efficacy of the three means was compared. Results 208 cases were treated with MPCNL, 92 cases with URL, and 20 cases with combination of percutaneous nephrostomy and transurethral ureteroscopic lithotripsy. The stone-free rate of one time was 96.6% ,90.2% and 100% ,respectively. Residual stones were removed by adjuvant therapy. No severe complication was noted during 1 to 28 months＇ of follow-up. Conclusions MPCNL is the best the treatment of ureteral calculi between the fourth and fifth lumbar vertebrae. URL is not the first choice and combination of percutaneous nephrostomy and transurethral ureteroscopy can be applied for some refractory cases.