输尿管镜下碎石术选择性治疗嵌顿性输尿管上段结石

目的探讨输尿管镜下碎石术治疗嵌顿性输尿管上段结石的术式选择方法。方法对187例单侧嵌顿性输尿管上段结石患者，根据结石的大小、输尿管梗阻情况、肾积水轻重、肾盂肾盏发育情况，选择不同的手术方法。62例采用MPCNL治疗；125例采用URL治疗，其中33例术后辅助ESWL治疗。结果MPCNL组术后3天结石清除率952％（59／62），术后1个月结石清除率100％（62／62）；URL组术后3天结石清除率36．8％（37／125），显著低于MPCNL组（p〈0,01），术后1个月结石清除率98．4％（123／125），与MPcNL组相比差异无显著性（p〉0．05）。结论MPCNL治疗嵌顿性输尿管上段结石有较高的结石清除率，URL效果稍差，但通过对不同情况的结石进行选择，配合ESWL可明显提高疗效。

Trans-ureteroscope Lithotripsy for impacted upper ureteric calculi after the selection of different cases of the calculi

Objective To probe to the means of selection of impacted upper ureteric calculi for Trans-ureteroscope Lithotripsy（TURL）. Methods A total of 187 patients were diagnosed as impacted upper ureteric calculi and were selected according to the different cases of the calculi,after the selection 62 patients received Minimal Invasive Percutaneous Nephrolithotomy; 125 patients received Trans-urethral Ureteroscope Lithotripsy,46 patients received auxiliary Extracorporeal Shock Wave Lithotripsy.The stone-free rate was recorded in 3 days and 1 month postoperation.Results In PCNL group,the stone-free rate was 95.2%（59/62） in 3 days postoperation,and it was 100%（62/62） in 1 month postoperation.In URL group, the stone-free rate was 36.8%（37/125） in 3 days postoperation,with the auxiliary ESWL,the stone-free rate was 98.4%（123/125） in 1 month postoperation. Conclusions High stone-free rate can be obtained with Minimal Invasive Percutaneous Nephrolithotomy for impacted upper ureteric calculi.The stone-free rate was less effective with Trans-urethral Ureteroscope Lithotripsy,but the result can be mostly raised with auxiliary ESWL after the selection of the different cases of the calculi.