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目的比较两种微创手术治疗体外碎石失败后的输尿管上段结石的疗效。方法回顾分析2004年6月～2010年2月某院行体外碎石治疗失败后237例输尿管上段结石患者,采用微创经皮肾穿刺取石术与经尿道输尿管镜碎石术治疗,对比两种方法的临床疗效。其中143例采用MPCNL进行治疗;94例采用URL治疗后,32例接受辅助的ESWL治疗。结果 MPCNL组术后3d结石清除率为95.8%(137/143),术后1个月结石清除率为100%(143/143)。URL术后3d结石清除率为32.7%(31/94),术后1个月的结石清除率为90.5%(85/94),均显著低于MPCNL组(P=0.0006)。结论微创经皮肾穿刺取石治疗嵌顿性输尿管上段结石有很高的结石清除率;经尿道输尿管镜手术治疗效果稍差,可以联合体外冲击波碎石来提高疗效。
Objective To compare the efficacy of two minimally invasive surgeries in the treatment of upper ureteral calculi after failure of extracorporeal gravel. Methods A retrospective analysis of 237 patients with upper ureteral calculi after an unsuccessive treatment of gravel in a hospital from June 2004 to February 2010 was performed with minimally invasive percutaneous nephrolithotomy and transurethral ureteroscopic lithotripsy. Methods of clinical efficacy. Of these, 143 were treated with MPCNL; 94 received URL-based therapy and 32 received ESWL-assisted therapy. Results The stone clearance rate was 95.8% (137/143) in MPCNL group at one month after operation. The stone clearance rate was 100% (143/143) at 1 month after operation. The stone clearance rate was 32.7% (31/94) on postoperative day 3 and 90.5% (85/94) at 1 month postoperatively, both of which were significantly lower than those of MPCNL group (P = 0.0006). Conclusion Minimally invasive percutaneous nephrolithotomy in the treatment of incarcerated upper ureteral calculi has a very high rate of stone removal; transurethral ureteroscopic surgery is less effective and can be combined with extracorporeal shock wave lithotripsy to improve efficacy.