微创经皮肾镜与输尿管软镜治疗输尿管上段单发大结石的疗效比较  

Prospective comparative study between minimally invasive percutaneous nephrolithotomy and flexible ureteroscopy in the management of single large stone in the proximal ureter

作　　者：李纪华[1] 景治安[1] 毛长青[1] 刘彦军[1] 王定占[1] 冯战启[1] 

机构地区：[1]郑州市第一人民医院泌尿外科,河南郑州450004

出　　处：《中国现代医生》2015年第4期32-35,共4页China Modern Doctor

摘　　要：目的比较微创经皮肾镜与输尿管软镜在治疗输尿管上段单发大结石的临床疗效及相对优势。方法选择输尿管上段单发大结石并轻中度积水患者,依据与患者意愿相结合的原则分为微创经皮肾镜组与输尿管软镜组,比较两组的一般资料、手术时间、术后住院时间、并发症发生率及清石率。结果将我院2010年9月~2013年12月间收治的98例同类患者纳入研究对象,微创经皮肾镜组共51例,输尿管软镜组共47例,术前的一般资料包括性别、年龄及肾积水程度无显著差异。两组结石的大小分别为（18.5±2.7）mm、（17.9±2.5）mm（P=0.274）;手术时间分别为（55.6±13.5）min、（79.3±20.5）min（P〈0.01）;术后住院时间（5.3±1.2）d、（2.3±0.9）d（P〈0.01）;采用ClavienDindo并发症分级系统,Ⅱ级并发症发生率分别为7.8%、6.4%（P=0.779）。结论对于输尿管上段单发大结石患者,微创经皮肾镜及输尿管软镜均是有效的外科治疗方法,两者比较可见微创经皮肾镜有更高的碎石效率,缩短了手术时间,但输尿管软镜有创伤更小、康复更快等优势。Objective To investigate the difference and relative advantages between minimally invasive percutaneous nephrolithotomy（MPCNL） and flexible ureteroscopy（FURS） in the management of surgically indicated single large stone in the proximal ureter. Methods Patients with single large stone in the proximal ureter with mild to moderate hydronephrosis were prospectively selected and assigned into groups of MPCNL and FURS on the basis of the patient choice. Demographic data, operative duration, postoperative hospital stay, complication rate and stone-free rate were recorded and compared. Rsults From September 2010 to December 2013, 98 patients were consecutively included into the study. 51 cases in MPCNL group, while 47 cases in FURS group. No significant difference was found in preoperative demographics, including age, sex and severity of hydronephrosis. The mean stone size was（18.5±2.7） and（17.9±2.5）mm（P=0.274）, the mean operative time were（55.6±13.5）and（79.3±20.5） minutes（P0.01）, the mean postoperative hospital stay were（5.3 ±1.2） and（2.3 ±0.9） days（P 0.01）, and complication rate over grade Ⅱ（modified Clavien system） were7.8% and 6.4%（P=0.779） in MPCNL and FURS groups respectively. Conclusion Both MPCNL and FURS are equally effective and safe surgical options for patients with single large stone in the proximal ureter when indicated. MPCNL provides higher stone-free rate and has shorter operative time, however, FURS is associated with faster recovery and less invasiveness than MPCNL in supine position.

关 键 词：微创经皮肾镜 输尿管软镜 输尿管结石 

分 类 号：R699.2[医药卫生—泌尿科学]