微创经皮输尿管镜与逆行输尿管镜治疗梗阻性输尿管上段结石疗效比较.pdf

上海交通大学
硕士学位论文
微创经皮输尿管镜与逆行输尿管镜治疗梗阻性输尿管上段结石
的疗效比较
姓名:夏圻儿
申请学位级别:硕士
专业:外科学(泌尿外科)
指导教师:孙晓文
20090501
微创经皮输尿管镜与逆行输尿管镜
治疗梗阻性输尿管上段结石的疗效比较

摘要

目的: 比较微创经皮输尿管镜(L)与逆行输尿管镜(URL)
治疗梗阻性输尿管上段结石的疗效和安全性。
材料和方法: 对92例梗阻性输尿管上段结石的患者,分别行微创
经皮输尿管镜(45例)和逆行输尿管镜(47例)碎石治疗, 其中6例辅助
体外冲击波碎石术(ESWL)治疗。结石横径均>10mm。纳入研究的梗
阻性输尿管上段结石定义为结石位于肾盂输尿管连接部至第四腰椎横突
水平之间且静脉肾盂造影片中造影剂不能到达结石以下部位。分析比较
两组患者的碎石成功率、手术时间、术后恢复时间、术后3天、术后1月
的结石清除率、术中术后并发症、住院费用等项目。
结果: 微创经皮输尿管镜组(L)碎石成功率、术后3日和术
后1月的结石清除率均明显高于逆行输尿管镜组(URL),分别为(% v
%;P=)、(% v %;P=)和(100% v %;P=
)。微创经皮输尿管镜组平均手术时间、术后平均住院时间和平均
住院费用均明显高于逆行输尿管镜组。分别为(± v ±
minutes;P <) (± v ± days;P <)和(10533± v
± yuan;P <)。URL组中6例辅助体外冲击波碎石术
(ESWL)治疗,无严重并发症,%。
结论: 对于结石横径>10mm的梗阻性输尿管上段结石,微创经皮
输尿管镜与逆行输尿管镜比较,前者更易取净结石,术后近期并发症少,
疗效更确切,但手术时间和住院时间较长,住院费用较贵。经尿道输尿
管镜碎石治疗效果较差,但联合体外冲击波碎石治疗可提高疗效。

关键词: 输尿管结石,输尿管镜,经皮肾镜碎石
Comparison of minimally invasive percutaneous antegrade
ureterolithotripsy and retrograde ureterolithotripsy
for large impacted proximal ureteric calculi



ABSTRACT


Purpose: pared the safety and efficacy of percutaneous
antegrade ureterolithotripsy and retrograde ureterolithotripsy for large
impacted proximal ureter stones.
Materials and Methods: A group of 92 patients with large impacted
proximal ureteral stones, defined as stones greater than 10mm and located
from the ureteropelvic junction to the 4th lumbar vertebra, 45 patients
received antegrade ureterolithotripsy ,47 patients received retrograde
ureterolithotripsy, 6 patients received auxiliary ext racorporeal shock wave
lithotripsy. Failure of intend procedure intraoperative and postoperative
morbidity, operative time, hospital stay, hospitalization expenditure, stone
fragmentation rate, stone clearance at discharge home and follow-up were
analyzed in each group.
Results: Percutaneous antegrade ureterolithotripsy