微创经皮肾取石及经尿道输尿管镜碎石治疗输尿管上段结石疗效比.docVIP

微创经皮肾取石及经尿道输尿管镜碎石治疗输尿管上段结石疗效比 　【关键词】 输尿管结石 Comparison of minimally invasive percutaneous nephrolithotomy and transurethral ureteroscopic Lithotripsy for upper ureteric calculi 　　ABSTRACT: 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 stonefree rate was recorded in 3 days and 1 month postoperation. Results 3 days and 1 month after MPCNL, the stonefree rate was 97.8%(90/92) and 100%(92/92) respectively. 3 days after URL, the stonefree rate was 20.9%(23/110). A month after the auxiliary ESWL, the stonefree rate was 84.5%(93/110). Conclusion High stonefree rate can be obtained with minimally invasive percutaneous nephrolithotomy for impacted upper ureteric calculi. The stonefree rate is less satisfactory with transurethral ureteroscopic lithotripsy, but the result can be improved with auxiliary ESWL. 　　KEY WORDS: ureteric calculi; ureterscope; percutaneous nephrolithotomy 　　摘要：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(Plt;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。 　　关键词：输尿管结石；输尿管镜；经皮肾穿刺取石术 　　不能通过保守治疗排出的输尿管上段结石，目前多首选体外冲击波碎石(ESWL)[1]。但是对于嵌顿性结石、结石以下尿路存在狭窄或扭曲、合并同侧肾结石、严重肾功能不全的病例，ESWL的疗效多不理想[2-3]。1996年6月至2004年6月，我们对临床诊断为嵌顿性输尿管上段结石的患者202例，分别采用微创经皮肾穿刺取石术(MPCNL)和经尿道输尿管镜碎石术(URL)为主的两种方法进行治疗，对其临床疗效进行比较，报告如下。 　　1 资料与方法 　　1.1 临床资料 患者202例，男118例，女84例；年龄17-77岁，平均年龄为45岁；左侧输尿管结石87例，右侧115例。腰部疼痛或不适151例，尿路刺激症状44例，肉眼血尿37例，无症状体检发现结石27例，ESWL治