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目的:探讨应用钬激光在输尿管镜碎石术及微创经皮肾穿刺取石术处理输尿管上段嵌顿性结石的疗效和并发症的比较。方法:2009年2月～2011年6月我院182例输尿管上段嵌顿性结石患者,应用钬激光经URL治疗85例,MPCNL治疗97例,对两种方法疗效进行临床评价比较。结果:MPCNL术中一期碎石清除率为(93/97)95.88%,5例残石者残石大小0.2～0.4 mm,术后1月结石清除率为(97/97)100%,平均手术时间75±29 min,平均住院时间为12±5 d,平均住院费用14589±3284 RMB;URL术一期碎石清除率为(39/85)45.88%,46例残石者残石大小0.3～1.5 mm,需术后联合体外冲击波碎石术等治疗排石,术后1月结石清除率为(72/85)84.71%,平均手术时间102±43 min,平均住院时间为6±3 d,平均住院费用9086±1259 RMB。MPCNL术中有1例因穿刺后出血改行二期MPCNL术。URL术中输尿管扭曲、狭窄、息肉出血视野模糊不清,需改行切开取石术6例,结石移位到肾内改行MPCNL术11例。结论:对于嵌顿性输尿管上段结石,采用MPCNL和URL联合钬激光治疗各有其优缺点。MPCNL安全、高效、并发症少、创伤小、结石清除率高;URL相对具有恢复快、住院时间短、费用较低等优点,但结石移位发生率、残石率较高,需其他辅助方式治疗结石。因此输尿管上段嵌顿性结石的手术方式选择应根据结石位置、大小、梗阻程度、肾积水量、患者经济状况,术前检查结果,充分评估手术风险和难度,结合患者个体差异,术者的经验制定出最佳治疗方案。
Objective: To investigate the efficacy and complications of holmium laser lithotripsy and minimally invasive percutaneous nephrolithotomy in the treatment of incarcerated upper ureteral calculi. Methods: From February 2009 to June 2011, 182 patients with upper ureteral incarcerated stones in our hospital were treated with holmium laser by URL, 85 patients were treated by MPCNL and 97 patients were treated by MPCNL. The clinical evaluation of the two methods were compared. Results: The first stage lithotripsy in MPCNL was (93/97) 95.88%, the residual stone size was 0.2-0.4 mm in 5 cases, and the rate of stone clearance in January was (97/97) 100%. The mean The operation time was 75 ± 29 min, the average length of hospital stay was 12 ± 5 days, and the average hospitalization cost was 14 589 ± 3284 RMB. The first stage lithotripsy of URL was (39/85) 45.88%, the residual stone size of 46 ~ 1.5 mm. Postoperative combined extracorporeal shock wave lithotripsy was required. The stone clearance rate at January was 84.71% (72/85), the average operation time was 102 ± 43 minutes and the average length of stay was 6 ± 3 days , The average cost of hospitalization 9086 ± 1259 RMB. One patient underwent MPCNL to undergo second-stage MPCNL due to bleeding after puncture. URL surgery ureteral distortions, stenosis, polyp bleeding vision blurred, need to divert to cut open stone surgery in 6 cases, stone shift to the renal transformation MPCNL in 11 cases. Conclusions: For incarcerated ureteral calculi, both MPCNL and URL combined with holmium laser have their advantages and disadvantages. MPCNL is safe, efficient and has fewer complications, less trauma and higher stone clearance rate. URL has the advantages of faster recovery, shorter hospitalization time and lower cost. However, the incidence of stone metastasis and residual stone are higher, and other auxiliary methods Treatment of stones. Therefore, the upper ureteral incarcerated stone surgical approach should be based on the location of stone, size, obstruction, hydronephrosis, the economic status of patients, preoperative examination results, fully assess the risk and difficulty of surgery, combined with individual patient differences, the surgeon’s Experience to develop the best treatment options.