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目的:探讨软性镜输尿管与经皮肾镜治疗输尿管上段结石的临床疗效及优势的对比分析。方法:选取吉林大学中日联谊医院泌尿外科2013年6月~2015年6月收治的输尿管上段结石(长径大于2cm)患者共计151例,其中既往行体外碎石失败者63例,重度肾盂积水者45例,既往行输尿管硬镜手术史者48例,结石息肉包裹者17例,输尿管上段狭窄合并结石者23例。89例行经皮肾镜碎石术(PCNL),作为对照组;62例患者行软性输尿管镜碎石术(FURS),作为实验组,对两组病例的手术时间、并发症发生率、术后住院时间、结石清除率进行统计学分析,对比两种手术术式在治疗输尿管上段结石中的临床疗效和各自的优势。结果:实验组和对照组患者年龄分别为(47.9±9.1)和(46.6±11.9)岁(P=0.605);结石大小分别为(26.2±5.6)和(27.4±6.6)mm(P>0.05);手术时间分别为(77.1±10.1)和(42.4±6.2)min(P<0.001);手术并发症发生率分别为12.90%和26.97%(P=0.167);术后无石率(残留结石≤3mm)分别为83.9%和87.6%(P>0.05);术后住院时间分别为(2.7±0.7)和(5.1±0.7)d(P<0.001)。结论:在治疗输尿管上段大结石中,输尿管软镜及经皮肾镜均是有效的外科治疗方法,两者比较一期无石率无明显差别,但经皮肾镜缩短了手术时间,而软性输尿管镜的应用越来越广泛,相对于经皮肾镜具有微创、住院时间短等优点。
Objective: To explore the clinical efficacy and advantages of soft ureter and percutaneous nephrolithotomy in the treatment of upper ureteral calculi. Methods: A total of 151 patients with upper ureteral calculi (long diameter> 2 cm) were enrolled in the Department of Urology, Sino-Japanese Friendship Hospital, Jilin University, China from June 2013 to June 2015. Among them, 63 cases had failed ex vivo gravel, Water in 45 cases, both previous ureteroscopic surgery in 48 cases, stone polyps wrapped in 17 cases, upper ureteral stricture with stones in 23 cases. 89 patients underwent percutaneous nephrolithotomy (PCNL) as the control group; 62 patients underwent soft ureteroscopic lithotripsy (FURS) as the experimental group, the operation time, the incidence of complications, Postoperative hospital stay, stone clearance rate of statistical analysis, compared with the two surgical procedures in the treatment of upper ureteral calculi clinical efficacy and their respective advantages. Results: The age of the patients in the experimental group and the control group were (47.9 ± 9.1) and (46.6 ± 11.9) years old (P = 0.605), respectively. The stone sizes were (26.2 ± 5.6) and (27.4 ± 6.6) mm ; The operation time was (77.1 ± 10.1) and (42.4 ± 6.2) min (P <0.001) respectively. The incidences of complications were 12.90% and 26.97% (P = 0.167) 3 mm) were 83.9% and 87.6% respectively (P> 0.05). The postoperative hospital stay was (2.7 ± 0.7) and (5.1 ± 0.7) days (P <0.001), respectively. Conclusions: In the treatment of upper ureteral calculi, ureteroscopic and percutaneous nephrolithotomy are both effective surgical treatments. There is no significant difference between the two groups in the stone free rate, but the percutaneous nephrolithotomy shortens the operation time and the soft Ureteroscopic applications more and more widely, compared with percutaneous nephrostomy with minimally invasive, shorter hospital stay and so on.