长径大于等于1.5厘米输尿管上段结石的腔内治疗

目的 比较经尿道输尿管镜取石术(URL)与微创经皮肾镜取石术(MPCNL)治疗长径≥1.5 cm输尿管上段结石的疗效.方法 对58例长径≥1.5 cm的输尿管上段结石分别采用URL(URL组,35例)和MPCNL(MPCNL组,23例)治疗,比较两组疗效.术前所有患者均做超声及IVU检查.结果 URL组中13例结石被完全清除,成功率37.1%(13/35);8例结石部分返回肾盂,需结合体外冲击波碎石术(ESWL);7例因输尿管扭曲严重,3例因输尿管狭窄,4例因术野不清改行MPCNL或开放手术;平均手术时间为38min.MPCNL组中21例经一次手术清除结石,成功率91.3%(21/23);2例因患肾残留结石须行ESWL,平均手术时间为34 min.两组成功率比较,差异有统计学意义.结论 相对于URL而言,MPCNL是一种治疗长径≥1.5 cm输尿管上段结石安全而有效的方法.

Upper-ureteral calculi ≥1.5 cm: treatment by endourological procedure

Objective To compare ureteroscopic hthotomy (URL)and minimally invasive percuta-neous nephrolithotomy (MPCNL) for the management of upper-ureteral calculi ≥ 1.5 cm. Methods Fifty-eight patients with upper-ureteral calculi ≥ 1.5 cm were selected in randomized for URL group (35patients)or MPCNL group (23 patients). Ultrasonography and intravenous X-ray were performed for all pa-tients before surgery. Results In the URL group, 13 cases (37.1%)were rendered stone-free, 8 stones mi-grated upward to the pelvis of kidney. In these cases,a double- J stent was inserted, and ESWL was per-formed,7 cases had ureteral distortion, 3 cases had ureteral stricture, 4 cases had bad field of vision, MPCNL or open operation was performed in these eases. The mean operative time was 38 minutes (range 25-48 min-utes). In the MPCNL group,21 eases (91.3%)were rendered stone-free. In the other 2 patients,ESWL was performed because the stone fragments migrated upward to the pelvis of kidney. The mean operative time was 34 minutes (range 20-58 minutes). Conclusion Compared with URL,MPCNL is a safe and effective procedure for treating upper-ureteral calculi ≥ 1.5 cm.