中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2008年
8期
553-556
,共4页
孙晓文%夏术阶%LU Jun%凡杰%WEN Wei%张捷%刘海涛%LI Wei-guo%朱轶勇%LI Zhong-zhong
孫曉文%夏術階%LU Jun%凡傑%WEN Wei%張捷%劉海濤%LI Wei-guo%硃軼勇%LI Zhong-zhong
손효문%하술계%LU Jun%범걸%WEN Wei%장첩%류해도%LI Wei-guo%주질용%LI Zhong-zhong
尿结石%腔内手术%外科手术,选择性
尿結石%腔內手術%外科手術,選擇性
뇨결석%강내수술%외과수술,선택성
Urinary calculi%Endoscopic surgery%Surgical procedures,elective
目的 总结输尿管上段结石的有效治疗方法. 方法回顾性分析体外冲击波碎石(ESwL)、逆行输尿管镜(URL)或微创经皮输尿管镜碎石(MPCNL)治疗397例输尿管上段结石患者的临床效果,统计学比较3种治疗方法的成功率及结石清除率.结果 397例患者中,ESWL治疗83例,结石横径0.8～1.5 cm,平均1.23 cm;改行URL或开放手术治疗13例(15.7%);单纯ESWL治疗术后1个月结石清除率为65.7%(46/70).URL治疗213例,结石横径0.7～1.8 cm,平均1.21cm;改行开放手术18例(8.5%);单纯URL治疗术后1个月结石清除率为88.2%(172/195).MPCNL治疗101例,结石横径0.9～2.5 cm,平均1.50 cm;改行开放手术治疗3例(3.0%);单纯MPCNL治疗术后1个月结石清除率为96.9%(95/98).结石横径≤1 cm者.ESWL治疗结石清除率低于URL和MPCNL治疗组(P=0.041),URL组与MPCNL组结石清除率比较差异无统计学意义(P=0.680);结石横径＞1 cm者,ESWL治疗结石清除率低于URL组和MPCNL组(P＜0.001),URL组结石清除率低于MPCNL组(P=0.005).结论 横径≤1 cm的输尿管上段结石首选ESWL治疗,＞1 cm的结石应选用URL或MPCNL治疗,MPCNL治疗的结石清除率更高.
目的 總結輸尿管上段結石的有效治療方法. 方法迴顧性分析體外遲擊波碎石(ESwL)、逆行輸尿管鏡(URL)或微創經皮輸尿管鏡碎石(MPCNL)治療397例輸尿管上段結石患者的臨床效果,統計學比較3種治療方法的成功率及結石清除率.結果 397例患者中,ESWL治療83例,結石橫徑0.8～1.5 cm,平均1.23 cm;改行URL或開放手術治療13例(15.7%);單純ESWL治療術後1箇月結石清除率為65.7%(46/70).URL治療213例,結石橫徑0.7～1.8 cm,平均1.21cm;改行開放手術18例(8.5%);單純URL治療術後1箇月結石清除率為88.2%(172/195).MPCNL治療101例,結石橫徑0.9～2.5 cm,平均1.50 cm;改行開放手術治療3例(3.0%);單純MPCNL治療術後1箇月結石清除率為96.9%(95/98).結石橫徑≤1 cm者.ESWL治療結石清除率低于URL和MPCNL治療組(P=0.041),URL組與MPCNL組結石清除率比較差異無統計學意義(P=0.680);結石橫徑＞1 cm者,ESWL治療結石清除率低于URL組和MPCNL組(P＜0.001),URL組結石清除率低于MPCNL組(P=0.005).結論 橫徑≤1 cm的輸尿管上段結石首選ESWL治療,＞1 cm的結石應選用URL或MPCNL治療,MPCNL治療的結石清除率更高.
목적 총결수뇨관상단결석적유효치료방법. 방법회고성분석체외충격파쇄석(ESwL)、역행수뇨관경(URL)혹미창경피수뇨관경쇄석(MPCNL)치료397례수뇨관상단결석환자적림상효과,통계학비교3충치료방법적성공솔급결석청제솔.결과 397례환자중,ESWL치료83례,결석횡경0.8～1.5 cm,평균1.23 cm;개행URL혹개방수술치료13례(15.7%);단순ESWL치료술후1개월결석청제솔위65.7%(46/70).URL치료213례,결석횡경0.7～1.8 cm,평균1.21cm;개행개방수술18례(8.5%);단순URL치료술후1개월결석청제솔위88.2%(172/195).MPCNL치료101례,결석횡경0.9～2.5 cm,평균1.50 cm;개행개방수술치료3례(3.0%);단순MPCNL치료술후1개월결석청제솔위96.9%(95/98).결석횡경≤1 cm자.ESWL치료결석청제솔저우URL화MPCNL치료조(P=0.041),URL조여MPCNL조결석청제솔비교차이무통계학의의(P=0.680);결석횡경＞1 cm자,ESWL치료결석청제솔저우URL조화MPCNL조(P＜0.001),URL조결석청제솔저우MPCNL조(P=0.005).결론 횡경≤1 cm적수뇨관상단결석수선ESWL치료,＞1 cm적결석응선용URL혹MPCNL치료,MPCNL치료적결석청제솔경고.
Objective To evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL), retrograde ureterolithotripsy(URSL) and percutaneous ureterolithotripsy(PCL) in the treatment of proximal ureteral calculi. Methods A total of 397 patients with proximal ureteral calculi treated by ESWL,URSL or PCL ftom September 2001 to December 2005 were retrospectively analyzed. Results Among 397 patients,83 patients with a mean stone size of 1.23 cm were treated by ESW L.Of then.13 patients transferred to URSL or ureterolithotomy and the stone-free rate of ESWL 1 month later was 65.7%(46/70).TWO hundred and thirteen patients with a mean stone size of 1.21 cm were treated by URSL and 101 patients with a mean stone size of 1.50 cm were treated by PCL.The stone-free rate of URSL and PCL 1 month after the treatment was 88.2%(172/195)and 96.9%(95/98),respectively.Eighteen patients in URSL group and 3 patients in PCL group trans-ferred to ureterolithotomy.ESWL had a statistically lower stone-free rate than that of URSL and PCL (P＜0.001),both in patients with stone size≤1 cm and＞1 cm.For patients with stone size＞1 cm,PCL achieved a higher stone-free rate than URSL(P=0.005).PCL also had a higher stone-free rate than URSL in treating patients with stone size≤1 cm but there was no statistical difference between them. Conclusions ESWL can still be used as first-line treatment choice for proximal ureteral stones less than 1cm.For patients with proximal ureteral stones larger than 1cm.URSL and PCL are more proper treatment modalities since they can achieve higher stone-free rate and have acceptable low complications.
