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目的:比较输尿管硬镜联合NTrap网篮碎石术与经皮肾镜取石术(PCNL)治疗输尿管上段嵌顿性结石的疗效差异。方法:回顾性分析本院2011年6月~2014年2月共150例输尿管上段直径≥15mm,或者输尿管上段直径≥10mm,经过ESWL治疗失败的嵌顿性结石微创治疗患者的临床资料,其中93例采用硬性输尿管镜联合NTrap网篮碎石术治疗,57例采用PCNL进行治疗。比较分析两组术前一般情况,手术成功率、术后清石率、手术时间、术后住院时间及围手术期并发症的发生情况。结果:两组患者手术成功率分别为88.17%(82/93)和100%(57/57),术后1个月清石率分别为86.02%(80/93)和100%(59/59),术后住院时间分别为(4.68±0.91)d和(7.14±0.79)d,术后输血率分别为0和5.26%(3/57),以上各项差异均有统计学意义(P<0.05);手术时间分别为(39.03±7.81)min和(37.98±6.04)min,术后发热发生率分别为10.75%(10/93)和10.52%(6/57),差异无统计学意义(P>0.05)。结论:对于输尿管上段直径≥15mm的嵌顿性结石,或者直径≥10mm,经过ESWL治疗失败的患者,PCNL是安全、具有较高清石效率的手术方案选择。
OBJECTIVE: To compare the curative effects of ureteroscopic combined with NTrap mesh lithotripsy and percutaneous nephrolithotomy (PCNL) in the treatment of upper ureteral incarcerated stones. Methods: A retrospective analysis of our hospital from June 2011 to February 2014 a total of 150 cases of ureteral diameter ≥ 15mm, or upper ureteral diameter ≥ 10mm, after ESWL failed treatment of incarcerated stone minimally invasive treatment of clinical data, including Ninety-three patients underwent ureteroscopy combined with NTrap mesh grafting, and 57 were treated with PCNL. The two groups were compared before and after the general situation, the success rate of surgery, postoperative stone rate, operation time, postoperative hospital stay and perioperative complications. Results: The successful rates of operation in the two groups were 88.17% (82/93) and 100% (57/57), respectively. The rates of stone removal at one month after operation were 86.02% (80/93) and 100% (59/59) ), And postoperative hospital stay were (4.68 ± 0.91) d and (7.14 ± 0.79) days, respectively. The postoperative blood transfusion rates were 0 and 5.26% (3/57), respectively. All the above differences were statistically significant (P < 0.05). The operative time was (39.03 ± 7.81) min and (37.98 ± 6.04) min respectively. The incidence of postoperative fever was 10.75% (10/93) and 10.52% (6/57) respectively, with no significant difference P> 0.05). CONCLUSIONS: PCNL is safe and has a high clear stone efficiency in patients with incarcerated stones ≥15 mm in diameter at the distal ureter or in patients ≥10 mm in diameter who have failed ESWL.