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目的比较输尿管软镜钬激光碎石术(FURS)与经皮肾镜钬激光取石术(PCNL)治疗输尿管上段结石的临床疗效。方法选取2011年7月-2014年4月收治的结石直径6~10mm及行体外冲击波碎石术(ESWL)失败结石直径10~20mm的输尿管上段结石患者217例236侧。采用FURS 97例(104侧)作为FURS组,采用PCNL 120例(132侧)作为PCNL组。比较2组治疗结石的手术时间、碎石成功率、血红蛋白下降值、术后住院天数和并发症。结果 FURS组手术均顺利完成,术后发热8例(2.1%),未出现严重并发症。PCNL组手术均顺利完成,术后发热9例(7.5%),术中、术后明显出血3例,经选择性肾动脉栓塞治愈2例,经选择性肾动脉栓塞治无效,行患侧肾切除1例。FURS组手术时间长于PCNL组,血红蛋白下降值小于PCNL组,住院天数短于PCNL组,差异均有统计学意义(P<0.05);2组一期结石清除率比较差异无统计学意义(P>0.05)。结论对于结石直径6~10mm行ESWL失败及结石直径10~20mm的输尿管上段结石,FURS碎石与PCNL疗效相近,均为安全有效的治疗方法,但FURS取石术后患者恢复更快。
Objective To compare the clinical efficacy of ureteroscopic holmium laser lithotripsy (FURS) and percutaneous nephroscope holmium laser lithotripsy (PCNL) in the treatment of upper ureteral calculi. Methods A total of 217 patients with upper ureteral calculi with a diameter of 6 ~ 10 mm and an ESWL stone diameter of 10 ~ 20 mm were treated from July 2011 to April 2014. FURS 97 cases (104 sides) as the FURS group, PCNL 120 cases (132 sides) as the PCNL group. The operation time, gravel success rate, hemoglobin decrease, postoperative hospital days and complication were compared between the two groups. Results The operation of FURS group was successfully completed. Postoperative fever occurred in 8 patients (2.1%) without serious complications. The operation of PCNL group was completed successfully, 9 cases (7.5%) had postoperative fever, 3 cases had obvious hemorrhage during operation and after operation, 2 cases were cured by selective renal artery embolization and ineffective by selective renal artery embolization. Excision of 1 case. The operation time of FURS group was longer than that of PCNL group, the hemoglobin value was lower than PCNL group, hospitalization days were shorter than PCNL group, the difference was statistically significant (P <0.05). There was no significant difference in the stone clearance rate between the two groups (P> 0.05). Conclusions FURS lithotripsy and PCNL are similar and effective in the treatment of upper ureteral calculi with stones of 6-10mm in diameter and 10-20mm stones in diameter, all of which are safe and effective. However, patients recover faster after FURS lithotripsy.