不同术式治疗输尿管上段结石的临床疗效和安全性

目的：探讨经皮肾镜下气压弹道碎石术和微创经皮肾镜碎石术在输尿管上段结石患者中的应用及效果。方法：选择2010年12月-2011年12月在我院泌尿外科收治的96例输尿管上段结石患者为研究对象，应用随机数字表法将符合本研究纳入标准和排除标准的患者分为A组和B组，A组患者给予微创经皮肾镜碎石术治疗，而B组患者给予经皮肾镜下气压弹道碎石术治疗，比较A组和B组患者在手术所需时间、术中出血量、术后住院时间、术后住院费用、碎石成功率、结石排尽率及并发症发生率等疗效指标。结果：B组患者在手术所需时间、术中出血量、术后住院时间、术后住院费用明显少于／低于A组，有显著性差异（P〈0．05）；B组患者碎石成功和结石排尽率明显少于／低于A组，有显著性差异（P〈0．05）；B组患者性欲和性高潮情况明显差于A组，有显著性差异（P〈0．05）。但是，两组患者在手术并发症方面差异无显著性（P〉0．05）。结论：经皮肾镜下气压弹道碎石术具有手术时间短、术中出血少、术后住院时间短和术后住院费用低等特点。而微创经皮肾镜碎石术治疗输尿管上段结石具有排石成功率和结石取尽率均很高等特点，因此，结石较大、停留时间较长的患者最好选择输尿管气压弹道碎石术治疗，反之，则选用微创经皮肾镜碎石术治疗。

Curative effect and safety of different surgical methods in the treatment of upper ureteral calculi

Objectives： To investigate the curative effect of pereutaneous nephrolithotomy pneumatic ballistic lithotripsy and minimally invasive pereutaneous nephrolithotomy lithotripsy in the treatment of upper ureteral calculi. Methods： We selected 96 cases of upper ureteral calculi patients from our hospital from December 2010 to December 2011 and divided them into group A and group B. We treated group A and group B with minimally invasive pereutaneous nephrolithotomy lithotripsy and pereutaneous nephrolithotomy pneumatic lithotripsy treatment respectively, and compared the operation time, blood loss, postoperative hospital stay, postoperative hospital costs, gravel success rate, stones drained rate and complication rate. Results： For patients in group B, their surgery time, blood loss, postoperative hospital stay and postoperative hospital stay costs are significantly less than those of patients in group A （ P 〈 0.05 ）. The success rate of gravel and drain of group B is significantly lower than that of group A （ P 〈 0. 05 ）. The libido and sexual orgasm of the patients in group B are significantly worse than those in group A. There is no sig- nificant difference in surgical complications （ P 〉 0. 05 ）. Conclusions： Pereutaneous nephrolithotomy pneumatic ballistic litho- tripsy treatment requires shorter operation time, less blood loss, shorter postoperative hospital stay and postoperative hospital stay and lower cost while minimally invasive percutaneous nephrolithotomy lithotripsy treatment achieves higher success rate of gravel and stone draining. As a result, for patients who have larger stone size and longer residence time, percutaneous nephrolithotomy pneumatic lithotripsyis is more favorable; otherwise, minimally invasive percutaneous nephrolithotomy lithotripsy treatment should be adopted.