【摘要】 目的分析三种术式治疗输尿管上段结石(UUC)的临床疗效。方法我院收治的350例UUC患者,按不同术式分为体外组[n=220,体外冲击碎石术(ESWL)]、激光组[n=96,输尿管硬镜钬激光碎石术(URHL)]和肾镜组[n=34,经皮肾镜取石术(PCNL)],比较三组手术指标、结石清除率、术后不良事件与结石复发率。结果体外组手术用时、失血量、住院耗时、治疗费用小于激光组与肾镜组(P<0.05),激光组手术用时、失血量、住院耗时小于肾镜组(P<0.05),治疗费用与肾镜组差异无统计学意义(P>0.05)。激光组和肾镜组结石总清除率、直径>1.5cm的结石清除率均高于体外组(P<0.05),但激光组和肾镜组之间差异无统计学意义(P>0.05)。体外组与激光组术后并发症总发生率均低于肾镜组,激光组与肾镜组结石复发率均低于体外组(P<0.05)。结论 ESWL在微创、高效康复方面具有优势,但较大体积的结石清除情况不理想,复发风险高;URHL、PCNL在各体积结石清除、减少复发方面具有优势,但经济压力大。在实际临床治疗中需根据患者具体情况进行合理选择。更多还原

【Abstract】 Objective To analyze the therapeutic effects of three types of surgical methods for upper ureteral calculi( UUC).Methods According to differentsurgical methods,350 patients with UUC admitted to our hospital were divided into an extracorporeal group( n = 220) treated with extracorporeal shock wave lithotripsy( ESWL),a laser group( n = 96) treated with ureteroscopic holmium laser lithotripsy( URHL) and a nephroscope group( n = 34) treated with percutaneous nephrolithotomy( PCNL). Surgical indexes,stone clearance rate,postoperative adverse events and stone recurrence rate were compared among the three groups. Results The operation time,blood loss,length of hospital stay and treatment cost of the extracorporeal group were significantly shorter or less than those of the laser group and the nephroscope group( P<0.05). The operation time,blood loss and length of hospital stay of the laser group were shorter or less than those of the nephroscope group( P<0.05),but there was no significant difference in treatment cost between the two groups( P>0.05). There was no significant difference in the total stone clearance rate and the clearance rate of stoneswith a diameter>1.5 cm between the laser group and the nephroscope group( P>0.05),but the two indicators in the laser group and the nephroscope group were significantly higher than those in the extracorporeal group( P<0.05). There was no significant difference in the total incidence of postoperative complications between the extracorporeal group and the laser group( P>0.05),but the total incidence in the two groups was significantly lower than that in the nephroscope group( P<0.05). There was no significant difference in stone recurrence rate between the laser group and the nephroscope group( P>0.05),but the stone recurrence rate in the two groups was significantly lower than that in the extracorporeal group( P<0.05). Conclusion ESWL has advantages in minimally invasive and efficient rehabilitation. However,the clearance rate of larger stones is not ideal,and there is a high risk of recurrence. URHL and PCNL have advantages in removing stones of various sizes and reducing recurrence,but the treatment cost is high. In clinical treatment,the surgical method should be chosen according to the patient’s specific condition.更多还原