CAJ | 학술논문

目的：比较两种内镜应用于治疗输尿管上段结石伴肾盂中重度积水的效果。方法输尿管上段结石患者伴肾盂中重度积水60例，随机分成两组，经皮输尿管软镜组（软镜组）和经皮输尿管硬镜组（硬镜组），每组30例。选择第11～12肋间或第12肋下，肩胛下和腋后线间范围为穿刺点，在B超引导下穿刺进入目标肾盏：软镜组用输尿管软镜经peel－away鞘顺行法寻找到肾盂进入输尿管，寻找到结石后用钬激光碎石；硬镜组用输尿管硬镜按上述方法寻找输尿管结石并碎石。结果软镜组结石排净率93．3％（28／30），硬镜组70．0％（21／30），两组比较，差异有统计学意义（χ2＝5．45，P＝0．0195）。软镜组手术时间（67±15）min，硬镜组（51±13）min，差异有统计学意义（t＝2．35，P＝0．0250）。术后软镜组2例（6．7％）发热，硬镜组3例（10．0％）发热，两组比较差异无统计学意义。结论合并肾盂中重度积水的上尿路结石，采用经皮肾输尿管软镜顺行碎石，虽然时间长于硬镜组，但结石取净率高。
목적：비교량충내경응용우치료수뇨관상단결석반신우중중도적수적효과。방법수뇨관상단결석환자반신우중중도적수60례，수궤분성량조，경피수뇨관연경조（연경조）화경피수뇨관경경조（경경조），매조30례。선택제11～12륵간혹제12륵하，견갑하화액후선간범위위천자점，재B초인도하천자진입목표신잔：연경조용수뇨관연경경peel－away초순행법심조도신우진입수뇨관，심조도결석후용화격광쇄석；경경조용수뇨관경경안상술방법심조수뇨관결석병쇄석。결과연경조결석배정솔93．3％（28／30），경경조70．0％（21／30），량조비교，차이유통계학의의（χ2＝5．45，P＝0．0195）。연경조수술시간（67±15）min，경경조（51±13）min，차이유통계학의의（t＝2．35，P＝0．0250）。술후연경조2례（6．7％）발열，경경조3례（10．0％）발열，량조비교차이무통계학의의。결론합병신우중중도적수적상뇨로결석，채용경피신수뇨관연경순행쇄석，수연시간장우경경조，단결석취정솔고。
Objective To compare two endoscopies used in upper ureteral calculi with moderate and severe hydronephrosis in renal pelvis .Methods Sixty patients with upper ureteral calculi complicated by middle-high grade nephrohydrops were randomly di-vided into two groups , the percutaneous flexible ureteroscopy group ( flexible ureteroscopy group ) and the percutaneous rigid ureteros-copy group ( rigid ureteroscopy group ) , 30 patients in each group .The range between infrascapular line and postaxillary line under the eleventh or twelfth rib were as puncture point , and then the target renal calculi were seeked under the ultrasound guidance .In flexible ureteroscopy group , the renal calculi and ureter were seeked by flexible ureteroscopy through the peel -away sheath anterograde mehtod , and then holmium laser lithotripsy was performed for the ureteral calculi .In rigid ureteroscopy group ,the seeking procedures were per-formed by rigid ureteroscopy , and the method was the same as the flexible ureteroscopy group .Results In flexible ureteroscopy group, the lithagogue rate was 93.3%(28/30), that in rigid ureteroscopy group was 70%(21/30), the former was higher than the latter, the difference was statistically significant (χ2 =5.45,P=0.0195).In flexible ureteroscopy group , the operation time was (67 ± 15) min, in rigid ureteroscopy group (51 ±13) min, the difference was statistically significant (t=2.35,P=0.0250).Two patients in flexible ureteroscopy group (6.7%) had fever after surgery , three patients in rigid ureteroscopy group (10%) had fever, the differ-ence between the two groups was not statistically significant .Conclusions There were fewer complications and higher stone free-rates in the patients with upper ureteral calculi complicated by middle-high grade nephrohydrops , by using percutaneous anterograde flexible lithotripsy.