【摘要】 目的比较经皮肾镜取石术(PCNL)与输尿管镜下碎石术(URL)处理输尿管上段结石的疗效及安全性。方法回顾性分析2013年9月至2015年12月中山大学附属第三医院岭南医院收治的159例单侧输尿管上段结石患者。根据治疗手段分为PCNL组和URL组,分析比较两种取石方法的结石清除率、手术时间、术后血红蛋白下降值、术后并发症和住院时间。结果 PCNL组与URL组的总结石清除率分别为97.4%(76/78)和87.7%(71/81),差异有统计学意义(P<0.05)。当结石长径≥1.5 cm时,PCNL组结石清除率明显高于URL组(100%vs.81.8%,P=0.002),但住院时间比URL组延长[(8.3±3.2)d vs.(5.1±2.7)d,P=0.034],术后血红蛋白下降值大于URL组[(9.7±2.4)g/L vs.(4.1±2.2)g/L,P=0.000],而手术时间及并发症发生情况相比差异无统计学意义(P>0.05)。当结石长径<1.5 cm时,PCNL组的手术时间、并发症、住院时间和血红蛋白下降值均大于URL组(P<0.05),而结石清除率差异无统计学意义。结论处理输尿管上段结石时,URL具有微创、并发症少、住院时间短等优点,尤其适用于结石较小(长径<1.5 cm)者,而对于较大的结石(长径≥1.5 cm),PCNL术更具优势。更多还原

【Abstract】 Objective To compare the efficacy and safety between ureteroscope lithotripsy(URL) and percutaneous nephrolithotomy(PCNL) in treating the proximal ureteral calculi. Methods Patients with proximal ureteral calculi who were treated between September 2013 and December 2015 in our hospital were retrospectively analyzed. In the study, 159 patients were underwent PCNL or URL treatment respectively. The stones free rate, operative time, blood loss(average hemoglobin decrease), complications and mean hospital stay were compared. Results The total stones free rates in PCNL group and URL group were 97.4%(76/78) and 87.7%(71/81), and there was no significant difference(P<0.05). With proximal ureteral stones≥1.5 cm, it showed significantly higher stones free rate in the PCNL than the URL group(100% vs. 81.8%, P=0.002), but the mean hospital stay was longer in the PCNL than the URL group [(8.3±3.2)d vs(5.1±2.7)d, P=0.034] and the hemoglobin decrease was higher in the PCNL than the URL group [(9.7±2.4)g/L vs(4.1±2.2)g/L, P=0.000]. There was no significant difference in the mean hospital stay and complications(P>0.05). With proximal ureteral stones<1.5 cm, the operative time, complications, mean hospital stay and hemoglobin decrease were higher in PCNL group than URL group(P<0.05), but stones free rates showed no significant difference. Conclusion For proximal ureteral calculi, URL has the advantage of more minimal invasive, less complications and shorter mean hospital stay and it is suitable for little stones(<1.5 cm). And PCNL was more suitable for treating big stones(≥1.5 cm).更多还原