不同途径腔内碎石治疗输尿管上段嵌顿结石的疗效对比

目的 探讨腔内碎石治疗输尿管上段嵌顿结石的最佳途径。方法 将94例体外冲击波碎石（ESWL）失败的输尿管上段嵌顿结石患者随机分组，50例采用经尿道输尿管镜碎石（URL），44例经皮肾微造瘘输尿管镜碎石（MPCNL），并对临床资料进行比较。结果 URL组术后1周结石清除率22．00％。其余病例均因结石或较大碎石漂移到肾内而需联合ESWL，联合ESWL后1个月结石清除率为96．00％。MPCNL组术后1周结石清除率为95．45％，1个月结石清除率为97．73％。其中1例血尿明显，持续8d后停止。结论 MPCNL治疗输尿管上段嵌顿结石疗效更佳，结石清除率高。单用URL治疗效果较差，而联合ESWL可达到满意效果。

A Comparison of curative effect of using different endoscopic lithotripsy in treating impacted upper ureteral calculi

[Objective] To investigate the best approach of endoscopic lithotripsy in treating impacted upper ureteral calculi. [Methods] To randomly assign 94 cases of impacted upper ureteral calculi with failure of extracorporeal shock wave lithotripsy (ESWL), 50 of them were treated with trans-urethral ureteroscope lithotripsy (URL) and 44 with minimally invasive percutaneous nephrolithotomy (MPCNL), and then the clinical material were analyzed. [Results] The stone-free rate of one week after operation in URL group was 22.00%, all the rest cases needed for combination ESWL because of the calculi or some bigger fragments moving into the kidney, in combination with ESWL one month later the stone-free rate was 96.00%. In MPCNL group, the stone-free rate of one week and that of one month after operation were 95.45% and 97.73% respectively. One case of MPCNL had hematuria apparently due to percutaneous nephrostomy and the symptom lasted 8 days. [Conclusion] MPCNL was more effective in treating impacted upper ureteral calculi and had higher stone-free rate. The curative effect of using URL alone in treating impacted upper ureteral calculi was poor, but in combination with ESWL, the satisfactory results also can be obtained.