CAJ | 학술논문

目的探讨治疗上段输尿管结石的最佳方法.方法选取我院2010年3月至2014年10月收治的126例上段输尿管结石患者,随机分为三组,A组采用体外冲击波碎石术(Extracorporeal shock wave lithotripsy,ESWL),B组采用经尿道输尿管镜下碎石术(ureteroscope recessivelithotrity,URL),C组采用微创经皮肾碎石术(minimally invasive percutanenephrolithotomy,MPCNL).结果三组病例均通过微创手术治疗成功.三组治疗效果比较,MPCNL组的结石总清除率明显高于URL组和ESWL组,差异有统计学意义(P＜0.05),而手术导致输尿管梗阻高烧、感染性休克、大出血、肾损害、结石残留等并发症发生率三组差异无统计学意义(P＞0.05).结论以上三种微创治疗上段输尿管结石方法均为有效手段,经URL手术适应于有指症上段输尿管结石.MPCNL治疗腰3以上复杂结石具有优势.ESWL应掌握好适应证,根据患者的具体病情合理选择或联合应用可代替开放性手术、减少并发症、提高疗效.
목적 탐토치료상단수뇨관결석적최가방법.방법 선취아원2010년3월지2014년10월수치적126례상단수뇨관결석환자,수궤분위삼조,A조채용체외충격파쇄석술(Extracorporeal shock wave lithotripsy,ESWL),B조채용경뇨도수뇨관경하쇄석술(ureteroscope recessivelithotrity,URL),C조채용미창경피신쇄석술(minimally invasive percutanenephrolithotomy,MPCNL).결과 삼조병례균통과미창수술치료성공.삼조치료효과비교,MPCNL조적결석총청제솔명현고우URL조화ESWL조,차이유통계학의의(P＜0.05),이수술도치수뇨관경조고소、감염성휴극、대출혈、신손해、결석잔류등병발증발생솔삼조차이무통계학의의(P＞0.05).결론 이상삼충미창치료상단수뇨관결석방법균위유효수단,경URL수술괄응우유지증상단수뇨관결석.MPCNL치료요3이상복잡결석구유우세.ESWL응장악호괄응증,근거환자적구체병정합리선택혹연합응용가대체개방성수술、감소병발증、제고료효.
Objective To explore the best way for treating upper segment ureteral calculi.Methods 126 patients with upper segment ureteral calculi admitted into our hospital from March,2010 to October,2014 were selected and randomly divided into three group A,group B,and group C,42 cases for each group.Group A were treated with extracorporeal shock wave lithotripsy (ESWL),group B transurethral ureteroscopy lithotripsy (URL),and group C minimally invasive percutaneous renal lithotripsy (MPCNL).Results All patients in these three groups were successfully treated by minimally invasive surgery.The total calculi clearance rate was obviously higher in group C than in group A and group B,with statistical differences (P＜0.05).There were no statistical differences in the incidences of complications such as high ureteral obstruction caursed by operation,septic shock,hemorrhage,renal damage,calculi residual,etc.between these 3 groups(P＞0.05).Conclusions The three methods for upper segment ureteral calculi are effective.URL is a choice for upper segment ureteral calculi with indication and MPCNL for upper segment ureteral calculi above Lumbar 3.ESWL should be used under the condition that understanding the indications well.According to the patients' specific disease conditions,one or more of these three methods can be chosen to replace open surgery,so to reduce the surgical complications and improve the curative effect.