输尿管软镜与微通道经皮肾镜在输尿管上段结石治疗中的对比研究

Comparison of flexible ureteroscope lithotripsy and minimally invasive percutaneous nephrolithotomy in treatment of upper ureteral calculi

摘要:

目的??通过对输尿管软镜与微通道经皮肾镜碎石术（mini-PCNL）治疗输尿管上段结石的对比研究，探讨两种术式的安全性及有效性。方法?选取该院2012年12月-2014年12月60例输尿管上段结石患者为研究对象。按入院病历单双号分为奇、偶数，奇数为输尿管软镜组（A组），偶数为mini-PCNL（B组）。右侧28例，左侧32例，结石直径为0.9～2.0 cm，平均（1.50±0.25）cm；比较两组患者手术时间、术中出血量、结石清除率及并发症。结果?该研究60例手术均成功完成，手术时间分别为A组（86.50±12.81）min、B组（81.83±12.76）min，差异无统计学意义（P >0.05）。出血量分别为A组（2.20±0.58）ml、B组（12.53±2.12）ml，A组明显低于B组，差异有统计学意义（P <0.05）。术后即刻清石率，A组90.00%（27/30）、B组96.67%（29/30），1个月结石清除率分别为A组100.00%（30/30）、B组100.00%（30/30），两组间差异无统计学意义（P >0.05）。两组均无大出血、严重感染和输尿管损伤等并发症。结论?输尿管软镜碎石术治疗输尿管上段结石较mini-PCNL操作简单、创伤更小、更安全和疗效确切，是目前治疗输尿管上段结石较理想的手术方式，值得临床进一步推广应用。

Abstract:

Objective?To investigate the safety and efficacy of flexible ureteroscope and minimally invasive percutaneous nephrolithotomy in treatment of upper ureteral calculi.?Methods?From December, 2012 to December, 2014, 60 patients with upper ureteral calculi were selected as study objects. According to the order of admission, the patients were divided into odd groups and even groups. Odd group (A group) was treated with flexible ureteroscope holmium laser lithotripsy while even group (B group) was treated with minimally percutaneous nephrolithotomy holmium laser lithotripsy. 28 patients with right upper ureteral calculi and the other 32 patients with left upper ureteral calculi. The average diameter of calculi was (1.50 ± 0.25) cm. Then the operation time, intraoperative bleeding volumes, the stone clearance rate and complcations were compared.?Results?In comparion of flexible ureteroscope group and the percutaneous nephrolithotomy group, the average operation time was (86.50 ± 12.81) min for flexible ureteroscope, and (81.83 ± 12.76) min for Micro channel percutaneous nephrolithotomy, there was no significant difference (P > 0.05). The average amount of bleeding was (2.20 ± 0.58) ml for flexible ureteroscope, and (12.53 ± 2.12) ml for minimally invasive percutaneous nephrolithotomy. The amount of bleeding of flexible ureteroscope group was significantly lower than that of minimally invasive percutaneous nephrolithotomy, the difference has statistical significance (P < 0.05). After operation, stone clearance rate was 90.00 % (27/30) in flexible ureteroscope group, and 96.67 % (29/30) in minimally invasive percutaneous nephrolithotomy group. After 1 month, stone clearance rate was 100.00 % (30/30) in flexible ureteroscope group, and 100.00 % (30/30) in minimally invasive percutaneous nephrolithotomy group. There was no statistical significance (P > 0.05). There were no severe perioperative complications such as severe hemorrhage, ureteral perforation or septicemia occured.?Conclusions?The flexible ureteroscope lithotripsy was more simple and safe, more curative effect and less trauma than minimally invasive percutaneous nephrolithotomy in treatment of ureteral calculi. It could be a better alternative surgical method and be desirable to be further popularized for treating upper ureteral calculi.