顺行与逆行输尿管镜下钬激光碎石术治疗合并感染的输尿管结石比较

目的 比较顺行经皮肾输尿管镜下与逆行经尿道输尿管镜下钬激光碎石取石术治疗合并感染的输尿管结石过程中手术时间、并发症、血清C反应蛋白浓度的改变等,为选择手术方式提供依据.方法 选择2008年4月至2010年10月在我院住院手术治疗的合并感染的输尿管结石患者102例,根据手术适应证分组,45例接受经皮肾输尿管镜取石术,57例接受经尿道输尿管镜取石术.术前、术中、术后检查记录手术时间、住院时间、并发症等指标,并分别于术前第1天,手术后24h测定血清C反应蛋白含量,比较两组间有无差异.结果 两组患者在性别、年龄、结石大小、病程长短等方面无明显差异(P＞0.05);顺行经皮肾微造瘘组的手术成功率、一期结石清除率高于逆行手术组(P＜0.05),并发症发生率两组间比较差异无统计学意义(P＞0.05),PCNL组平均手术时间及住院时间较长(P＜0.05).术前两组血清CRP含量无差异,术后24h有明显差异(P＜0.05),顺行组较逆行组明显减少.结论 对于合并感染的输尿管结石的治疗,经皮肾输尿管镜取石术对机体全身的影响低于经尿道输尿管镜取石术,治疗方式的选择主要取决于结石的部位,对于第四腰椎平面以上的输尿管上段结石PCNL术更安全有效.

Comparison of the outcomes of retrograde and antegrade access ureterolithotripsy by Holmium laser for ureteric calculi concurrent infection

Objective To compare the outcomes of retrograde access lithotripsy(minimally invasive technique.And antegrade access lithotripsy(trans-ureteroscope,URL)for ureteric calculi concurrent infection.The safety and efficiency of these two methods were evaluated by comparing the operation time,complication rate and the level of C-reaction protein in serum.Methods A total of 102 patients with ureteric calculi concurrent infection were treated with Holmium laser ureterolithotripsy.According to operation indication,45 patients underwent PCNL and 57 ones underwent URL.The level of C-reaction protein in serum was monitored at the last day preoperative and the 24th hour postoperative,respectively.Results There was no differences on the sex,age,course between the two groups(P>0.05);About the success rate and stone free rate,antegrade approach was hihger than retrograde approach(P< 0.05).About complication rate,the two groups were simila(rP>0.05),but about the mean operating time and hospital stays,the PCNL group was longer(P<0.05).The differences of the level of C-reaction protein in serum on the last day preoperative was not significant in two groups(P>0.05);However,there were significant differences between the two sets at 24th hour postoperative.Conclusions Retrograde and antegrade access homium laser ureterolithotripsy for ureteric calculi concurrent infection are both safe and effective. The operating indications are mainly according to the stone position.For upper ureteric calculi concurrent infection,PCNL is safer and more efficient than URL.