体外冲击碎石术、输尿管硬镜钬激光碎石术及经皮肾镜取石术治疗输尿管上段结石的疗效对比分析  

Comparative analysis of efficacy of extracorporeal shock wave lithotripsy,ureteroscopic holmium laser lithotripsy and percutaneous nephrolithotomy on upper ureteral calculi

作　　者：汪磊 魏勇 董玉花 袁春燕 陈德钢[1] 彭家武[1] 徐鹏程[1] WANG Lei;WEI Yong;DONG Yu-hua;YUAN Chun-yan;CHEN De-gang;PENG Jia-wu;XU Peng-cheng(Department of Urology,1.Lu an People s Hospital,Lu an 237005,Anhui;Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing 210029;Nanjing Gaochun People s Hospital,Gaochun 211300,Nanjing,China)

机构地区：[1]六安市人民医院泌尿外科,安徽六安237005 [2]南京中医药大学附属医院泌尿外科,江苏南京210029 [3]南京市高淳人民医院泌尿外科,南京高淳211300

出　　处：《川北医学院学报》2021年第7期894-897,共4页Journal of North Sichuan Medical College

摘　　要：目的:分析比较体外冲击碎石术(ESWL)、输尿管硬镜钬激光碎石术及经皮肾镜取石术(PCNL)治疗输尿管上段结石的疗效。方法:根据治疗方法不同将94例输尿管上段结石患者分为ESWL组(n=35)、硬镜钬激光组(n=24)和PCNL组(n=35),比较三组的手术指标、结石清除率、术后并发症、结石复发率。结果:手术时间、术中出血量和住院时间:ESWL组<硬镜钬激光组<PCNL组(P<0.05);治疗费用:ESWL组<硬镜钬激光组、PCNL组(P<0.05)。三组对直径≤1.5 cm的结石清除率、对直径>1.5 cm的结石清除率及结石总清除率比较,差异无统计学意义(P>0.05)。PCNL组术后严重血尿发生率大于ESWL组、硬镜钬激光组(P<0.05)。PCNL组结石复发率低于ESWL组(P<0.05),硬镜钬激光组结石复发率与PCNL组和ESWL组比较,差异无统计学意义(P>0.05)。结论:ESWL、输尿管硬镜钬激光碎石术和PCNL对治疗输尿管上段结石效果均较好,但ESWL对直径>1.5 cm的结石清除效果不佳且易复发,输尿管硬镜钬激光碎石术治疗费用较高,PCNL创伤相对较大、术后恢复慢且成本较高。Objective:To analyze and compare the efficacy of extracorporeal shock wave lithotripsy(ESWL),ureteroscopic holmium laser lithotripsy and percutaneous nephrolithotomy(PCNL)in the treatment of upper ureteral calculi.Methods:94 patients with upper ureteral calculi were divided into ESWL group(n=35),ureteroscopic holmium laser group(n=24)and PCNL group(n=21)according to the different treatment methods.The surgical indexes,stone clearance rate,postoperative complications and stone recurrence rate of the three groups were compared.Results:Surgical time,intraoperative blood loss and hospital stay of ESWL group,ureteroscopic holmium laser group,and PCNL group increased in turn(P<0.05),and treatment cost of ESWL group,ureteroscopic holmium laser group and PCNL group increased in turn(P<0.05).There was no significant difference among the three groups in terms of the removal rate of stones≤1.5 cm,the removal rate of stones>1.5 cm,and the total stone clearance rate(P>0.05).The incidence of postoperative serious hematuria was higher in PCNL group than that in ESWL group and ureteroscopic holmium laser group(P<0.05).The stone recurrence rate in PCNL group was lower than that in ESWL group(P<0.05),there was no significant difference in the stone recurrence rate in ureteroscopic holmium laser group compared with PCNL group and ESWL group(P>0.05).Conclusion:ESWL,ureteroscopic holmium laser lithotripsy and PCNL are effective in the treatment of upper ureteral calculi,but ESWL is not effective in the removal of stones with diameter>1.5cm and easy to relapse.The treatment cost of ureteroscopic holmium laser lithotripsy is high,and PCNL has relatively large trauma,slow postoperative recovery and high cost.

关 键 词：输尿管上段结石 体外冲击碎石术 输尿管硬镜钬激光碎石术 经皮肾镜取石术 

分 类 号：R693.4[医药卫生—泌尿科学]