摘要
目的比较顺行微创经皮肾镜取石与逆行输尿管镜取石治疗复杂输尿管上段结石的疗效。方法134例复杂输尿管上段结石患者按入院时间随机分为两组:顺行组(经皮肾穿刺造瘘碎石MPCNL)67例,逆行组(经尿道输尿管镜下碎石URL)67例。分别进行腔内钬激光碎石,观察其疗效及并发症的发生。结果MPCNL组手术成功率100%(67/67),平均手术时间48.7min,无输尿管穿孔发生,术后3d无石率94.0%(63/67)。1例术后辅助体外碎石,3例术后并发高热。URL组手术成功率88.1%(59/67),8例术中因输尿管扭曲或结石下方息肉堵塞不能到达结石部位而改行其他治疗。平均手术时间65.7min,术后3d无石率61.2%(41/67),3例并发输尿管穿孔,14例术后辅助体外碎石,术后并发高热8例。顺行组手术时间短,结石取净率高,术中、术后并发症少,与逆行组比较,差异有显著性。结论顺行腔内钬激光碎石疗效好,副作用少,可作为治疗复杂输尿管上段结石的首选方法。
[ Objective] To investigate the effect of antegrade ureteroscopy in management of complicated upper ureteral calculi, and compare it with retrograde ureteroscopy. [Methods ] Totally 134 cases with complicated upper ureteral calculi were randomly divided into two groups： 67 patients received antegrade （mini-percutaneous nephrolithotomy, MPCNL） and 67 patients received retrograde （transurethral ureteroscopy lithotripsy, URL）. The efficacy and complications were observed. [Results] In the MPCNL group, the stone fragmentation rate on one session was 100%（67/67）, the average operation time was 48.7 minutes, the stone-free rate was 94.0%（63/67）in 3 postoperative days. High fever occurred in 3 patients, ESWL was performed in 1 patient; no severe complications were noted in other patients. In the URL group, the stone fragmentation rate on one session was 88.1%（59/67）. The average operation time was 65.7 minutes, the stone-free rate was 61.2%（41/67）in 3 postoperative days. High fever appeared in 8 patients, uretal perforation in 3 patients, ESWL was performed in 14 patients; no serious complications were noted in other patients. The operation time, stone-free rate, the incidence of operative and postoperative complications were significantly different among the two groups. [ Conclusion ] The therapy with antegrade ureteroscopy and holmium：YAG laser is safe and effective. It is indicated as the first choice of treatment for complicated upper uretal calculi.
出处
《中国内镜杂志》
CSCD
北大核心
2009年第10期1101-1103,共3页
China Journal of Endoscopy
