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目的探讨及对比斜仰卧位微创经皮肾镜(MPCNL)和输尿管软镜(F-URL)治疗输尿管上段结石的疗效。方法 60例输尿管上段结石患者,随机分为MPCNL组和F-URL组,每组30例。MPCNL组患者给予斜仰卧位微创经皮肾镜手术治疗,F-URL组患者给予输尿管软镜治疗。比较两组患者的手术时间、术中出血量、住院时间、一次性清石率及并发症发生情况。结果 F-URL组患者手术时间、术中出血量、住院时间均显著少于MPCNL组,差异具有统计学意义(t=4.344、3.539、6.633,P<0.01)。MPCNL组一次性清石率为97.1%(33/34),高于F-URL组的82.4%(28/34),差异具有统计学意义(χ~2=3.981,P<0.05)。MPCNL组术后并发症发生率为23.5%(8/34),高于F-URL组的5.9%(2/34),差异具有统计学意义(χ~2=4.221,P<0.05)。结论斜仰卧位微创经皮肾镜和输尿管软镜均是治疗输尿管上段结石的安全、有效的方法 ,对于结石直径大、肾积水严重采用斜仰卧位微创经皮肾镜碎石术,对于病情及肾积水较轻的患者采用输尿管软镜碎石术。
Objective To investigate and compare the curative effect of obliquely supine minimally invasive percutaneous nephrolithotomy (MPCNL) and ureteroscopy (F-URL) in the treatment of upper ureteral calculi. Methods Sixty patients with upper ureteral calculi were randomly divided into MPCNL group and F-URL group, 30 cases in each group. Patients in MPCNL group were treated with minimally invasive percutaneous nephrolithotomy in oblique supine position and patients in F-URL group were treated with ureteroscopic soft-lens. The operation time, intraoperative blood loss, hospitalization time, one-time rate of clear stone and complication were compared between the two groups. Results The operation time, intraoperative blood loss and hospital stay in the F-URL group were significantly less than those in the MPCNL group (t = 4.344, 3.539, 6.633, P <0.01). In the MPCNL group, the rate of one-time clear stones was 97.1% (33/34), which was higher than that in the F-URL group (82.4%, 28/34). The difference was statistically significant (χ ~ 2 = 3.981, P <0.05). The incidence of postoperative complication in MPCNL group was 23.5% (8/34), which was higher than that in F-URL group (5.9%, 2/34). The difference was statistically significant (χ ~ 2 = 4.221, P <0.05). Conclusion Oblique supine minimally invasive percutaneous nephrolithotomy and ureteroscopic ureteroscopy are safe and effective treatment of upper ureteral calculi, for large diameter stones, hydronephrosis serious using oblique supine minimally invasive percutaneous nephrolithotripsy, For patients with mild disease and hydronephrosis ureteroscopic lithotripsy.