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目的:通过对输尿管上段结石不同治疗方法疗效的比较分析,探讨不同情况下治疗输尿管上段结石最有效的手术方法。方法:比较研究体外冲击波碎石术(ESWL)、经尿道输尿管镜碎石术(URSL)、输尿管软镜(RIRS)、经皮肾镜取石术(PCNL)、后腹腔镜输尿管切开取石术(RLU)及肾盂输尿管切开取石术的不同适应证,根据患者自身情况选择合理并有效的术式。结果:直径<8 mm的输尿管上段结石,采取保守治疗,排石率达70.6%;直径8~10mm,采用ESWL,排石率达77.6%;直径>10mm,采用URSL术,排石率达74.2%,应用封堵器及拦截网篮,排石率可达85.1%;对于URSL治疗失败的肾盂肾盏结石伴/不伴盏颈狭窄的肾盏憩室内结石,可采取RIRS,排石率达58.6%;URSL失败或较大结石,采取PCNL术,排石率达84.8%;以上治疗失败及解剖结构异常的复杂结石患者可行RLU或开放手术,虽然排石率可达100%,但创伤大出血多。结论:对于直径≤10mm的输尿管上段结石,可采用保守、ESWL治疗;直径>10mm,可采用URSL、RIRS、PCNL;以上治疗失败及解剖结构异常的复杂结石患者可采用RLU或开放手术。URSL可应用封堵器及拦截网篮,提高手术成功率。
OBJECTIVE: To compare and analyze the curative effects of different treatment methods of upper ureteral calculi and to explore the most effective surgical methods for treating upper ureteral calculi under different conditions. Methods: Extracorporeal shock wave lithotripsy (ESWL), transurethral ureteroscopic lithotripsy (URSL), ureteroscopic (RIRS), percutaneous nephrolithotomy (PCNL), retroperitoneal ureterolithotomy RLU) and ureteropelvic lithotomy different indications, according to the patient’s condition to choose a reasonable and effective surgical procedures. Results: Ureteral stone with a diameter of less than 8 mm was treated conservatively with a rate of 70.6% and a diameter of 8 ~ 10 mm. ESWL achieved a rate of 77.6% and a diameter of 10 mm. URSL achieved a rate of 74.2 %, The application of occluders and blocking baskets, stone discharge rate up to 85.1%; for URSL failed treatment of pyelonephrosis with / without cervical stenosis of calyceal diverticula calculus, RIRS can be taken, the rate of row of stone up to 58.6%; URSL failure or larger stones, PCNL surgery, the rate of stone discharge 84.8%; the above treatment failure and anatomical complexities of patients with complicated stones RLU or open surgery feasible, although the rate of stone discharge up to 100%, but the trauma hemorrhage many. Conclusions: URSL, RIRS and PCNL can be used for the treatment of upper ureteral calculi with diameter less than or equal to 10mm. RLU or open surgery can be used in patients with complicated stones with unsuccessful treatment and anatomic abnormalities. URSL can be applied occluders and blocking basket, to improve the success rate of surgery.