微创经皮输尿管镜与逆行输尿管镜治疗嵌顿性输尿管上段结石的疗效比较

目的：比较微创经皮输尿管镜（MPCNI。）与逆行输尿管镜（URI，）治疗嵌顿性输尿管上段结石的疗效。方法：回顾分析92例临床资料，比较两种方法的碎石成功率、手术时间、术后恢复时间、术后3天、术后1个月的结石清除率及术中术后并发症。结果：MPCNI。组碎石成功率、术后3天和术后1个月的结石清除率均明显高于URI。组，分别为（97．8％vs．80．9％；P—0．009）、（95．5％VS．81．6％；P—0．045）和（100％VS．89．5％；P—0．027）。MPCNI。组平均手术时间、术后平均住院时间和平均住院费用均明显高于URI。组。分别为（74．9±18．5）VS．（33．1±15．0）min（P〈0．001），（7．2±1．9）VS．（3．9±1．3）d（P〈0．001）和（10533±l 123．2）VS．（5587．7±560．6）元（P〈0．001），手术失败率和术中、术后并发症两组差异无统计学意义。URI．组中6例辅助ES-WL,治疗，无严重许发症，1个月后结石清除率提高至92．9％。MPCNI。的碎石率和清石率优于URI．（P〈0．05）。结论：MPCNI。与URI。比较，前者更易取净结石．术后近期并发症少．疗效更确切，但手术时间和住院时间较长．仲院费用转昔．URl。治疗效果较尊，佴联合ESWI。可槔高疗效。

Comparison of Minimally Invasive Percutaneous Antegrade Ureterolithotripsy and Retrograde Ureterolithotripsy for Large Impacted Proximal Ureteric Calculi

Objective:We compared the safety and efficacy of percutaneous antegrade ureterolithotripsy and retrograde ureterolithotripsy for large impacted proximal ureter stones in a prospective randomized manner.Methods: Ninety-two cases were analyzed including the average time of operation,the rate of the overall fragment,the rate of the stone completely expelled,the average hospital stay,and the rate of complications.Results:Percutaneous antegrade ureterolithotripsy was associated with longer operative time(74.9±18.5) vs.(33.1±15.0) min(P<0.001).longer postoperative hospital stay(7.2±1.9) vs.(3.9±1.3) days(P<0.001) and more hospitalization expenditure(10533±1123.2) vs.(5587.7±560.6) Yuan(P<0.001).Nevertheless percutaneous antegrade procedure had higher stone fragmentation rate(97.8%vs.80.9%;P=0.009) and higher stone free rate both at discharge home(95.5%vs.81.6%;P=0.045) and 1 month after the procedure(100%vs.89.5%;P~-0.027). Conclusions:Percutaneous antegrade ureterolithotripsy is a valuable treatment modality for impacted proximal ureteral calculi and achieves higher stone-free rate than that of retrograde ureteroscopic lithotripsy.The drawbacks of antegrade procedure are longer operative time,hospital stay and hospitalization expenditure.The stone-free rate is less satisfactory with transurethral ureteroscopic lit hotripsy,but the result can be improved wit h auxiliary ESWL.