微创经皮肾碎石与经尿道输尿管镜碎石治疗输尿管上段结石的比较.docVIP

微创经皮肾碎石与经尿道输尿管镜碎石治疗输尿管上段结石的比较 　　作者：何士军，任宝明，张争春，王卫妮，马 龙，王录文，闵晓明 作者单位：西安市第一医院泌尿外科，陕西西安 710002 　　【摘要】 　　目的 比较微创经皮肾镜取石术(MPCNL)与输尿管镜取石术(URL)治疗输尿管上段结石的疗效。方法 从2003年1月至2005年12月，对240例单侧输尿管上段结石患者，123例采用MPCNL治疗，117例采用URL治疗后，40例接受辅助ESWL治疗。结果 MPCNL组临床治疗成功率为100%(123/123)，一次结石清除率为96%(119/123)。URL组临床治疗成功率为58.1%(68/117)，术后一次结石清除率47%(56/117)，术后辅助体外冲击波碎石，一个月结石清除率为84%(99/117)，均显著低于MPCNL组(P0.05)。结论 微创经皮肾穿刺碎石治疗输尿管上段结石，有较高的临床治疗成功率、结石清除率，虽然经尿道输尿管镜碎石治疗效果较差，但联合体外冲击波可提高疗效。 　　【关键词】 输尿管上段结石，输尿管镜，经皮肾穿刺碎石术 　　Comparison of minimally invasive percutaneous nephrolithotomy and transurethral ureteroscopic lithotripsy to treat upper ureteric calculi 　　He Shijun, Ren Baoming, Zhang Zhengchun, Wang Weini, Ma Long, Wang Luwen, Min Xiaoming 　　(Department of Urology, the First Hospital of Xian, Xian 710002, China)ABSTRACT: Objective To investigate the effect of minimally invasive percutaneous nephrolithotomy (MPCNL) in managing upper ureteric calculi, compared with transurethral ureteroscopic lithortripsy (URL). Methods From Jan. 2003 to Dec. 2005, of 240 patients with upper ureteric calculi, 123 received MPCNL, and 117 transurethral ureteroscopic lithortripsy. Of them, 40 patients received auxiliary extracorporeal shock wave lithoripsy (ESWL) afterwards. The stonefree rate was recorded after 1 day and 1 month postoperatively. Results 1 day and 1 month after MPCNL, the stonefree rate was 96% (119/123) and 100% (123/123) respectively, 1 day after URL, the stonefree rate was 47% (56/117). 1 month after the auxiliary ESWL, the stonefree rate was 84% (99/117). Conclusion High stonefree rate can be obtained with minimally invasive percutaneous nephrolithotomy for upper ureteric calculi. The stonefree rate is less satisfactory with transurethral ureteroscopic lithotripsy, but the result can be improved with auxiliary ESWL. 　　KEY WORDS: upper ureteric calculi; ureterscope; percutaneous nephrolithotomy 　　输尿管上段结石由于其空间位置结构的独特性，且易存在结石以下输尿管狭窄、迂曲、结石嵌顿、包裹,因此目前在微创经皮肾穿刺或经尿道输尿管镜途经治疗输尿管上段