微创经皮肾取石和经尿道输尿管镜碎石治疗输尿管上段结石的疗效比较

目的 比较微创经皮肾穿刺取石术与经尿道输尿管镜碎石术治疗输尿管上段结石的方法。方法 从1996年6月到2004年6月，对202例单侧输尿管上段结石的患者，92例采用MPCNL进行治疗；110例采用URL治疗后，46例接受辅助的ESWL治疗。结果 MPCNL组术后3d结石清除率为94．6％（87／92），术后1个月结石清除率为100％（92／92）。URL术后3d结石清除率为20．9％（23／110），术后1个月的结石清除率为84．5（93／110），均显著低于MPCNL组（P〈0．05）。结论 微创经皮肾穿刺取石治疗嵌顿性输尿管上段结石有很高的结石清除率；经尿道输尿管镜手术治疗效果稍差，可以联合体外冲击波碎石来提高疗效。

Comparison of minimally invasive percutaneous nephrolithotomy and transurethral ureteroscopic Lithotripsy for upper ureteric calculi

Objective To investigate the effect of minimally invasive percutaneous nephrolithotomy in management of upper ureteric calculi,compared with transurethral ureteroscope lithotripsy.Methods A total of 202 patients were diagnosed as having upper urteric calculi,92 of whom accepted minimally invasive percutaneous nephrolithotomy,and 110 accepted transurethral ureteroscopic lithotripsy.Of them 46 patients accepted auxiliary extracorporeal shock wave lithotripsy afterwards.The stone-free rate was recorded in 3 days and 1 month postoperation.Results 3 days and 1 month after MPCNL,the stone-free rate was 97.8%(90/92) and 100%(92/92) respectively.3 days after URL,the stone-free rate was 20.9%(23/110).A month after the auxiliary ESWL,the stone-free rate was 84.5%(93/110).Conclusion High stone-free rate can be obtained with minimally invasive percutaneous nephrolithotomy for impacted upper ureteric calculi.The stone-free rate is less satisfactory with transurethral ureteroscopic lithotripsy,but the result can be improved with auxiliary ESWL.