CAJ | 학술논문

目的探讨输尿管软镜碎石术(F-URL)与微通道经皮肾镜碎石术(mPCNL)治疗输尿管上段结石的疗效对比.方法选取本院2011年1月～2014年3月行微通道经皮肾镜碎石术(70例)和输尿管软镜碎石术(50例)的输尿管上段结石(直径＞ 1.5cm)患者,共120例.其中轻中度肾积水68例,重度积水52例.比较各组的术后住院时间、并发症数、一次性清石率、术前术后血红蛋白降幅及手术时间等方面的差异.结果对120例患者进行统计分析,其中F-URL与mPCNL组的术后一次性结石清除率比较,P＞0.05;在120例患者中F-URL比mPCNL术后平均住院时间短,P＜0.05.F-URL比mPCNL在轻中度肾积水组术前术后血红蛋白降幅小,P ＜0.05;F-URL与mPCNL在重度肾积水患者中术前术后血红蛋白降幅基本一致,P ＞0.05.F-URL比mPCNL在轻中度肾积水组手术时间短,P＜0.05;F-URL比mPCNL在重度肾积水组手术时间长,P ＜0.05.结论 F-URL和mPCNL均为治疗输尿管上段结石的安全、有效治疗方法;F-URL对输尿管上段结石并轻中度肾积水的患者是一种安全有效的治疗方式;mPCNL对输尿管上段结石并重度肾积水的患者是首要选择之一.
목적 탐토수뇨관연경쇄석술(F-URL)여미통도경피신경쇄석술(mPCNL)치료수뇨관상단결석적료효대비.방법 선취본원2011년1월～2014년3월행미통도경피신경쇄석술(70례)화수뇨관연경쇄석술(50례)적수뇨관상단결석(직경＞ 1.5cm)환자,공120례.기중경중도신적수68례,중도적수52례.비교각조적술후주원시간、병발증수、일차성청석솔、술전술후혈홍단백강폭급수술시간등방면적차이.결과 대120례환자진행통계분석,기중F-URL여mPCNL조적술후일차성결석청제솔비교,P＞0.05;재120례환자중F-URL비mPCNL술후평균주원시간단,P＜0.05.F-URL비mPCNL재경중도신적수조술전술후혈홍단백강폭소,P ＜0.05;F-URL여mPCNL재중도신적수환자중술전술후혈홍단백강폭기본일치,P ＞0.05.F-URL비mPCNL재경중도신적수조수술시간단,P＜0.05;F-URL비mPCNL재중도신적수조수술시간장,P ＜0.05.결론 F-URL화mPCNL균위치료수뇨관상단결석적안전、유효치료방법;F-URL대수뇨관상단결석병경중도신적수적환자시일충안전유효적치료방식;mPCNL대수뇨관상단결석병중도신적수적환자시수요선택지일.
Objectives To evaluate the outcomes of minimally invasive percutaneous nephrolithotomy (mPCNL) and flexible ureteroscopy lithotripsy (F-URL) for upper ureteral calculi.Methods From January 2011 to March 2014,120 patients with upper ureteral calculi (diameter ＞ 1.5) were include.These patients were divided into two groups.Minimally invasive percutaneous nephrolithotomy (mPCNL) was performed in 70 patients and flexible ureteroscopy lithotripsy (F-URL) was performed in 50 patients.All these patients include light and moderate hydronephrosis group (68cases),severe hydronephrosis group (42 cases).The following parameters of F-URL were compared with the mPCNL:postoperative hospitalization time,complications,one-time stone clearance rate,blood loss (the decline of hemoglobin before and after operation),and operative time.Results There is no significant difference between the groups of F-URL and mPCNL in one-time stone clearance(P ＞ 0.05),While The mean postoperative hospital days was shorter in the group of F-URL than the group of mPCNL in the 120 cases(P ＜ 0.05) ; The postoperative hemoglobin decrease was less in the group of F-URL than the group of mPCNL in the cases with light,moderate hydronephrosis(P ＜ 0.05) ; The postoperative hemoglobin decrease was almost the same in the groups of F-URL and the group of mPCNL in the cases with severe hydronephrosis.The operative time was shorter in the group of F-URL than the group of mPCNL in the cases with light or moderate hydronephrosis(P ＜0.05),while the operative time was longer in the group of F-URL than the group of mPCNL in the cases with severe hydronephrosis(P ＜0.05).Conclusions ①Both F-URL and mPCNL are effective and safe treatment for complicated upper ureteral calculi (diameter ＞ 1.5cm) ;②For those patients with light and moderate hydronephrosis,the F-URL is a safe and effective treatment;③For those patients with sever hydronephrosis,mPCNL is one of the best choice.