输尿管软镜与经皮肾镜治疗输尿管上段结石的疗效与优势对比  

Comparative study on curative effects between flexible ureteroscopy and percutaneous nephrolithotomy in the management of proximal ureteral calculi

作　　者：伦晓璐 赵亚伟[1] 张刚[1] 孔祥波[1] 

机构地区：[1]吉林大学中日联谊医院泌尿外科,长春130033

出　　处：《临床泌尿外科杂志》2015年第7期582-585,共4页Journal of Clinical Urology

摘　　要：目的：探讨输尿管软镜取石术（flexible ureteroscopy,FURS）与经皮肾镜取石术（percutaneous nephrolithotomy,PNL）治疗输尿管上段结石的疗效与优势。方法：2013年5月~2014年10月我院收治单侧单发输尿管上段结石（长径10~20mm）患者78例,其中30例行输尿管软镜取石术,48例行经皮肾镜取石术。从48例中随机抽取30例作为PNL组,对两组患者年龄、性别、肾盂积水程度、结石大小、手术时间、手术并发症发生率（依据clavien系统分级〔1〕）、结石清除率、术后住院时间、手术费用等进行统计学分析。结果：两组患者年龄、性别、肾盂积水程度差异无统计学意义。两组结石大小为（14.6±2.6）和（14.1±2.4）mm（P=0.408）,手术时间为（75.1±10.2）和（41.5±6.4）min（P〈0.001）,手术总并发症发生率为13.33%和26.67%（P=0.197）,一期术后无石率（残留结石≤3mm）为76.67%和93.33%（P=0.071）,术后3个月无石率为90%和100%（P=0.236）,术后住院时间为（2.7±0.7）和（5.1±0.7）d（P〈0.001）,住院费用为（37 089.1±1 325.5）和（26 549.5±854.9）元（P〈0.001）。结论：FURS与PNL均为治疗输尿管上段结石有效且安全的手术方法,FURS更具微创性,患者术后恢复快,住院时间更短,而PNL手术时间短,住院费用更低。Objective：To compare the efficacy between flexible ureteroscopy （FURS） and percutaneous nephro- lithotomy （PCNL） in the managemefit of proximal ureteral calculi. Method： From May 2013 to October 2014, a total of 78 patients with stones in the proximal ureter （10-20 mm） were treated in our hospital. There were 30 pa- tients treated with FURS and 48 patients undergoing mini-PCNL. Only 30 cases randomly choosed from the 48 pa- tients were involved in the study. Patients＇ age, gender, the degree of hydronephrosis, stone size, operation time, surgical complications （based on Clavien system）, stone-free rate, postoperative hospital stay and hospital cost were analyzed statistically and compared between the two groups . Result： No significant difference was found in age, gender and the degree of hydronephrosis. The statistical results were as follows： stone size was （14.6_＋2.6） mm and （14. l=k2.4） mm （P=0. 408） ~ operative duration was （75. l!10.2） min and （41.5=k6.4） min （P~ 0. 001） ~ total complication rate was 13.33 % and 26.67 % （P = 0.197） ; stone-free rate after a single procedure （re- sidualS3 mm） was 76.67% and 93.33% （P=0. 071）; stone-free rate afer three months was 90% and 100% （P=0. 236） postoperative hospital stay was （2.7±0.7） days and （5. 1±0.7） days （P〈0. 001） hospitalization cost was （37 089. 1±1 325.5） and （26 549.5±854.9） yuan （P〈0. 001） in FURS and PCNL groups respective- ly. Conclusion：Both FURS and PCNL are effective and safe surgical options for patients with single stone in the proximal ureter. FURS offers minimal invasion, short hospitalization time and quick recovery. PCNL provides short operation time and little hospitalization cost.

关 键 词：输尿管上段结石 输尿管软镜取石术 经皮肾镜取石术 

分 类 号：R693[医药卫生—泌尿科学]