URSL、FURS和MPCNL治疗输尿管上段嵌顿性结石的疗效和安全性的比较

目的 比较微创经尿道输尿管镜联合钬激光碎石取石术（URSL）、输尿管软镜联合钬激光碎石取石术（FURS）和经皮肾镜碎石取石术（MPCNL）3种术式的优缺点，探讨治疗上段输尿管嵌顿性结石的术式选取。方法 选取2015年1月—2017年12月广州医科大学附属第五医院上段输尿管结石（>15?mm）患者150例。将患者按1∶1∶1的比例随机分为URSL组、FURS组及MPCNL组。主要分析指标为治疗成功率、术后1个月的 结石清除率，次要分析指标为术中、术后的相关参数，以及与手术相关并发症的发生情况。结果 URSL组的治疗成功率和结石清除率为62.0%和72.0%；FURS组为82.0%和91.1%；MPCNL组为94.0%和96.0%。3组治疗成功率、平均手术时间、术后住院时间比较，差异有统计学意义（P?<0.05）；3组需辅助体外冲击波碎石术（ESWL）辅助率与术后1个月结石消除率比较，差异无统计学意义（P?>0.05）。URSL组的治疗成功率低于FURS组和MPCNL组。MPCNL组治疗成功率优于FURS组。URSL组平均手术时间、术后住院时间优于另外两组。结论 MPCNL和FURS具有大致相同的结石清除率，均优于URSL，可能更适用于上段输尿管嵌顿性结石的治疗。与MPCNL比较，FURS治疗失败及术后感染风险均较高。此外，如果患者不适合行全身麻醉或手术耐受力差，可考虑行URSL。

Comparison of the efficacy and safety of URSL, FURS and MPCNL for treatment of large upper impacted ureteral stones

Objective To compare mini-percutaneous nephrolithotomy (MPCNL), transurethral ureteroscope lithotripsy (URSL) and flexible ureteroscopy with holmium laser (FURS), and to evaluate which one is the best choice for large upper impacted ureteral stones. Methods Totally 150 consecutively enrolled patients with a large upper impacted ureteral stone (> 15?mm) were included. The patients were randomly divided (1 : 1 : 1) into the MPCNL, URSL, and FURS group. The main outcome measures were the success rate of treatment, the stone clearance rate 1 month after operation; the secondary outcome measures were the relevant parameters during and after operation, and the occurrence of complications related to operation. Results The success rate of treatment and stone clearance rate were 94.0% and 96.0% in the MPCNL group, 82.0% and 91.1% in the FURS group, and 62.0% and 72.0% in the URSL group. There were statistically significant differences in the success rate of treatment, average operation time and postoperative hospital stay among the three groups (P??0.05). The success rate of URSL group was lower than that of FURS group and MPCNL group. The success rate of MPCNL group was better than that of FURS group. The average operation time and postoperative hospitalization time of URSL group were better than those of the other two groups. Conclusions MPCNL and FURS have the same stone clearance rate, which are better than URSL, and may be more suitable for the treatment of upper ureteral impacted stones. Compared with MPCNL, failure of FURS treatment and postoperative infection risk were higher. In addition, if the patient is not suitable for general anesthesia or poor surgical tolerance, URSL can be considered.