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目的:比较微创经皮输尿管镜(MPCNL)与逆行输尿管镜(URL)治疗嵌顿性输尿管上段结石的疗效。方法:回顾分析92例临床资料,比较两种方法的碎石成功率、手术时间、术后恢复时间、术后3天、术后1个月的结石清除率及术中术后并发症。结果:MPCNL组碎石成功率、术后3天和术后1个月的结石清除率均明显高于URL组,分别为(97.8%vs.80.9%:P=0.009)、(95.5%vs.81.6%;P=0.045)和(100%vs89.5%:P=0.027)。MPCNL组平均手术时间、术后平均住院时间和平均住院费用均明显高于URL组。分别为(74.9±18.5)vs.(33.1±1 5.0)min(P<0.001),(7.2±1.9)vs.(3.9±1.3)d(P<0.001)和(10 533±1 123.2)vs.(5587.7±560.6)元(P<0.001),手术失败率和术中、术后并发症两组差异无统计学意义。URL组中6例辅助ESWL治疗,无严重并发症,1个月后结石清除率提高至92.9%。MPCNL的碎石率和清石率优于URL(P<0.05)。结论:MPCNL与URL比较,前者更易取净结石,术后近期并发症少,疗效更确切,但手术时间和住院时间较长,住院费用较贵。URL治疗效果较差,但联合ESWL可提高疗效。
Objective: To compare the efficacy of minimally invasive percutaneous ureteroscopy (MPCNL) and retrograde ureteroscopy (URL) in the treatment of incarcerated ureteral calculi. Methods: The clinical data of 92 cases were retrospectively analyzed. The success rates of gravel, operation time, postoperative recovery time, postoperative 3 days, postoperative stone clearance and intraoperative and postoperative complications were compared between the two methods. Results: The success rate of gravel in MPCNL group was significantly higher than that in URL group at 3 days and 1 month after operation (97.8% vs. 80.9%, P = 0.009, 95.5% vs. 81.6%; P = 0.045) and (100% vs 89.5%: P = 0.027). Mean operation time, average postoperative hospital stay and average hospitalization cost in MPCNL group were significantly higher than those in URL group. (74.9 ± 18.5) vs. (33.1 ± 1 5.0) min (P <0.001), (7.2 ± 1.9) vs. (3.9 ± 1.3) d (P <0.001) and (10 533 ± 1 123.2) vs (5587.7 ± 560.6) yuan (P <0.001). There was no significant difference between the two groups in the rate of operation failure and intraoperative and postoperative complications. There were 6 cases of ESWL-assisted ESWL treatment in the URL group without serious complications, and the stone clearance rate increased to 92.9% after 1 month. MPCNL was superior to URL (P <0.05) in the rate of gravel and stone clearance. Conclusion: Compared with URL, MPCNL is easier to take nephrolithiasis. There is less postoperative complications and more definite curative effect. However, the operation time and hospitalization time are longer, and the cost of hospitalization is more expensive. URL treatment is poor, but combined with ESWL can improve the curative effect.