逆行及顺行输尿管镜术处理输尿管上段嵌顿性结石疗效比较.docVIP

逆行及顺行输尿管镜术处理输尿管上段嵌顿性结石疗效比较 　 作者：王炜　王谷丰　蒋国华　温洪波　甄旭彦 【摘要】 　　目的 比较逆行与顺行输尿管镜术处理输尿管上段嵌顿性结石的疗效，并对其安全性与有效性进行评价。方法 采用输尿管镜术共治疗输尿管上段嵌顿性结石246例，其中逆行经尿道入路治疗186例，顺行经皮肾微造瘘入路60例。结果 逆行经尿道入路手术成功173例(93%)，平均手术时间35min，平均住院时间5d，无石率81.2%，22例需ESWL辅助治疗，出现手术并发症9例(4.8%)；顺行经皮肾微造瘘入路手术成功60例(100%)，平均手术时间55min，平均住院时间8d，无石率100%，无手术并发症发生。结论 逆行与顺行输尿管镜术处理输尿管上段嵌顿性结石均有较高的手术成功率与术后无石率；顺行入路的安全性与有效性更好，但手术时间及住院时间更长。 【关键词】 输尿管结石　输尿管镜术　逆行经尿道入路　顺行经皮肾微造瘘 　　Comparison of the outcomes of retrograde and antegrade access ureterolithotripsy for impacted upper ureteric calculi 　　ABSTRACT: Objective To compare the outcomes of retrograde and antegrade access ureterolithotripsy for impacted upper ureteric calculi and to assess the safety and efficiency of the two types of minimally invasive technique. Methods A total of 246 patients with impacted upper ureteric calculi were treated with ureterolithotripsy. The procedure was performed via retrograde transurethral access in 186 patients and via antegrade percutaneous nephrostomy tract in 60 patients. Results The success rate of retrograde approach was 93%. Mean operating time was 35 min with mean hospital stay of 5 days. The stone free rate was 81.2% at 1 month followup. 22 patients(11.8%) with residual calculi required ESWL combination. Complications were noted in 4.8%. The success rate of antegrade approach was 100%. Mean operating time was 55 min with mean hospital stay of 8 days. The stone free rate was 100% and no complication was noted. Conclusion Retrograde and antegrade access ureterolithotripsy for impacted upper ureteric calculi are safe and effective. Success rate and stone free rate of antegrade approach are higher than those of the retrograde approach. 　　KEY WORDS: calculi; ureteroscopy; retrograde transurethral access; antegrade percutaneous nephrostomy tract 　　输尿管上段嵌顿性结石单用体外冲击波碎石(ESWL)治疗的效果较差，由于结石多被息肉包裹，即使结石破碎亦不易排出。2002年10月至2004年5月，我们采用逆行经尿道与顺行经皮肾微造瘘输尿管镜取石术共治疗输尿管上段嵌顿性结石246例，并对两种治疗方法的疗效进行比较，现报告如下。 　　1 资料与方法 　　1.1 临床资料 本组246例患者，男157例，女89例，年龄19-82岁，平均39岁。反复腰