上尿路结石的现代治疗方法的探讨(附5178例报告）

目的：探讨上尿路结石的现代治疗方法。方法：回顾性分析2001年2月8日～2002年12月31日收治的5178例上尿路结石患者的临床资料。结果：5178例中，采用体外冲击波碎石术(ESWL)治疗1826例，输尿管镜取石术(URL)2157例，微创经皮肾镜取石术(mini-PCNL)1131例，腹腔镜输尿管切开取石术8例和开放手术56例，分别占总数的35．3％、41．7％、21．8％、0．2％和1．0％。ESWL治疗中，1个月后结石排净率为83．0％，2个月后结石排净率为86．0％，3个月后为86．5％。术后有13例发生输尿管石街，采用URL或PCNL取净。URL对输尿管中、下段结石取净率为100％，上段为76％，术中无输尿管穿孔和撕脱并发症发生。mini—PCNL对肾盂和输尿管上段结石的取净率为100％，鹿角形结石为93％。术中未见肾盂大穿孔和。肾皮质撕裂。术后79例输血，输血率为1．5％。腹腔镜治疗8例全部成功，无并发症发生。结论：上尿路结石可用腔内技术和ESWL治疗，开放手术几乎可避免。

The current therapy of upper urinary tract calculi:report of 5178 patients

Purpose:To investigate the current situation of treating upper urinary tract calculi.Method:The information of 5178 cases of upper urinary tract calculi which were treated by extracorporeal shock wave lithotripsy(ESWL), ureteroscopic lithotripsy(URL), mini-percutaneous nephrolithotomy(mini-PCNL) , laparoscopic ureterolithotomy and open surgery was analysed.Result:Of 5178 cases, 1826 cases were treated by ESWL, 2157cases by URL, 1131cases by mini-PCNL, 8 cases by laparoscopic ureterolithtomy, only 56 cases by open surgery, respectively 35.3 41.7 21.8 0.2and 1.0proportionate to total number. The stone-free rate of ESWL was 83% at 1 month, 86% at 2 months and 86.5at 3 months respectively. There were 13 steinstrasses after ESWL, and were rendered stone free with URL or mini-PCNL. The stone-free rate of URL was 100% for middle and lower ureteral stone, 76% for upper ureteral stone,respectively. There was no ureter perforation and avulsion happened. The stone-free rate of mini-PCNL was 100% for pelvic and upper ureteral stone, 93% for stag-horn stone respectively. And there was no big pelvic perforation and parenchyma laceration recorded, 79 cases required transfusions, and the transfusion rate was 1.5. All laparoscopic ureterolithotomies were success, and no complications happened.Conclusion:Upper urinary tract calculi can be managed by endourologic technique and ESWL, and open surgery is almost avoidable.