经皮肾镜碎石与小切口取石治疗输尿管上段嵌顿性结石的疗效比较  

Comparison of Percutaneous Nephrolithotomy and Mini-Incision Ureterolithotomy for Large Impacted Upper Ureteral Calculi

作　　者：陈亚梅[1] 熊海云 曾小明[1] 余明主[1] 谭公祥[1] 郑慧杰[1] TAN Gong-xiang;ZHENG Hui-jie(Department of Urology,the 94tt＇Hospital of the Chinese People＇s Liboration Arrng,Nanchang 330002,China;Department of Urology,the 7th Affiliated Hospital of Sun Yat sen University,Shenzhen 510275,China)

机构地区：[1]中国人民解放军第九四医院泌尿外科,南昌330002 [2]中山大学附属第七医院泌尿外科,广东深圳510275

出　　处：《南昌大学学报（医学版）》2018年第4期50-52,89,共4页Journal of Nanchang University：Medical Sciences

摘　　要：目的比较经皮肾镜碎石(PCNL)与小切口取石治疗输尿管上段嵌顿性结石的有效性和安全性。方法回顾性分析2014年1月至2017年6月因输尿管上段嵌顿性结石行手术治疗的患者的临床资料,采用PCNL术29例(PCNL组),小切口切开取石术20例(切开取石组)。比较2组手术时间、术中出血量、一期结石清除率、术后输血率、并发症发生率,以及住院时间和费用等。结果 PCNL组一期结石完全清除率低于切开取石组,但差异无统计学意义(96.6%比100.0%,P=0.401),PCNL组手术时间低于切开取石组[(44.9±9.6)min比(58.4±9.0)min,P<0.001],术中估计出血量[(38.6±23.1)mL比(18.3±12.4)mL,P<0.001]及住院费用[(21 085±1719)元比(10 887±1189)元,P<0.001]高于切开取石组。但2组在住院时间,输血率及术后发热等并发症方面差异均无统计学意义(P>0.05)。结论 PCNL和小切口切开取石处理输尿管上段嵌顿性结石都是有效的治疗手段,清石率高,PCNL比小切口取石出血风险大,费用高,可根据患者意愿和自身条件选择。Objective To compare the effectiveness and safety of percutaneous nephrolithoto my（PCNL） and mini incision ureterolithotomy in the treatment of large impacted upper ureteral calculi.Methods Clinical data of 49 patients treated between January 2014 and June 2017 for large impacted upper ureteral calculi were analyzed retrospectively.These patients were assigned to re ceive either PCNL（n 29） or mini incision ureterolithotomy group（n 20）.Operation time,esti mated blood loss, stone clearance rate, postoperative blood transfusion rate, complication inci dence,hospital stay and hospitalization costs were compared between the two groups. Results Compared with mini incision ureterolithotomy, PCNL treatment decreased complete stone clear ance rate（96.6% vs 100.0%,P=0.401） ,shortened operation time（（44.9±9.6） minutes vs （58.4 ± 9.0） minutes, P〈0.001）, and increased intraoperative estimated blood loss（（38.6±23.1） mL vs（18.3±12.4）mL,P〈0.001） and hospitalization costs（（21085±1719） yuan vs （10887±1189） yuan,P〈0.001）.There were no significant differences between the two groups in hospital stay, blood transfusion rate, and incidence of postoperative fever and other complications（P 〉0.05）. Conclusion Both PCNL and mini incision ureterolithotomy are effective for large impacted upper ureteral calculi with a high stone clearance rate.However,PCNL results in higher risk of hemor rhage and costs of hospitalization than mini incision ureterolithotomy. The decision should be made according to patient preference and availability of surgical equipment.

关 键 词：经皮肾镜检查 输尿管结石 输尿管碎石术 

分 类 号：R693.4[医药卫生—泌尿科学]