嵌顿性输尿管上段结石取石术的术式比较

目的评价微创经尿道输尿管镜碎石术(URL)及微创经皮肾穿刺取石术(MPCNL)治疗嵌顿性输尿管上段结石患者的疗效。方法 60例嵌顿性输尿管上段结石患者,分成观察组和对照组。对照组:采用传统的体外冲击波碎石术(ESWL)治疗。观察组:结石位置偏低,积水较少的患者采用URL手术;结石体积较大,肾积水较明显且结石位置接近肾盂者采用MPCNL手术。结果观察组术后3d结石清除率(70.00%)及术后1个月结石清除率(97.50%)均高于对照组术后3d结石清除率(25.00%)及术后1个月结石清除率(35.00%),具有显著性差异(P0.01)。两组患者在治疗期间并发症发生率,差异没有统计学意义(P0.05)。结论微创的URL及MPCNL手术治疗嵌顿性输尿管上段结石患者疗效佳,而且也比较安全,值得临床推广应用。

Comparison of Two Procedures for Impacted Upper Ureteral Calculi

Objective To evaluate the curative efficacy of minimally invasive transurethral ureteroscope lithotripsy （URL） and minimally invasive percutaneous nephrolithotomy（MPCNL） in the treatment of impacted upper ureteral calculi. Methods Eighty cases of impacted upper ureteral calculi were divided into observation group and control group. The control group was treated by using extracorporeal shock wave hthotripsy （ESWL）and in the observation group, those with low location stones and less water were treated by using URL and those with larger stones, more obvious hydronephrosis and stones near the pelvis were treated by using MPCNL. Results In the observation group, the stone clearance rate 3 days after surgery was 70.00% and the stone clearance rate one month after surgery was 97.50%, higher than those of the control group （25.00% and 35.00%, respectively）, with a significant difference between the two groups （P〈0.01）. There was no significant difference in the complication incidence in the treatment between the two groups （P〉0.05）. Conclusion URL and MPCNL for impacted upper ureteral calculi show good efficacy and safety, worthy of clinical application.