肋上通道经皮肾镜取石术治疗输尿管上段结石临床疗效观察

目的探讨肋上通道经皮肾镜取石术(PCNL)治疗输尿管上段结石的安全性及临床疗效。方法回顾性分析2009年6月—2010年6月64例输尿管上段结石患者的临床资料,其中34例行肋上通道PCNL为A组,30例行肋下通道PCNL为B组,比较两组的手术时间、清石率及出血量。结果 64例患者均Ⅰ期完成手术,无穿刺失败或中转开放手术。A组手术时间(55.2±9.2)min,出血量(69.0±16.3)ml,清石率为97.1%,术后复查尿路平片1例患者结石跑入肾盏,需二次手术,无输血及严重并发症发生。B组手术时间(62.3±11.2)min,出血量(112.5±23.5)ml,清石率为80.0%,1例患者术中出血明显,给予输血2 U,6例患者残余结石>0.4 mm,需进一步处理。两组患者手术时间、出血量及清石率比较,差异均有统计学意义(P<0.05)。结论肋上通道PCNL治疗输尿管上段结石安全、有效,临床效果显著。

To Evaluate the Safety and Efficacy of the Supracostal Access for PCNL in the Treatment of Upper Ureter Calculi

Objective To explore the safety and efficacy of upper ureter stones with supracostal approach PCNL.Methods From June 2009 to June 2011,64 patients with upper ureter calculi were treated by PCNL.Of these,34 patients were treated by supracostal approach PCNL(group A) and 30 patients by subcostal approach(group B).The operative time,efficacy and hemorrhage quantity were compared between the two groups.Results All 64 cases had the operation finished in one stage without defeat in puncturing and changing to open surgery.In group A,operation time was(55.2±9.2)min,hemorrhage quantity was(69.0±16.3)ml,one case need a second time operation,and stone-free rate was 97.1%(33/34).In group B,the operation time was(62.3±11.2)min,hemorrhage quantity was(112.5±23.5)ml,one case transfused RBC 2 U,the stone-free rate was 80.0%(24/30).Both group A and B had no significant complications.The differences between the two groups in operation time,hemorrhage quantity and stone-free rate were statistically significant(P<0.05).Conclusion Supracostal access for PCNL is safe and effective in the treatment of upper ureter stones.