标准通道与微通道经皮肾镜取石术治疗输尿管上段结石疗效的比较

摘要

目的：比较标准通道和微通道经皮肾镜取石术（ percutaneous nephrolithotomy ，PCNL）治疗输尿管上段结石的临床效果。方法回顾性分析PCNL治疗67例输尿管上段结石的临床资料，根据不同工作通道分为标准通道组（ n＝36）和微通道组（n＝31），比较2组手术时间、术后结石清除率、并发症等。结果2组在手术时间[（42．3±8．9） min vs．（46．3± 10.4） min，t＝-1．697，P＝0．095]、一期结石完全清除率[97．2％（35/36） vs．93．5％（29/31），χ2＝0．018，P＝0．894]、术后血红蛋白下降值[（12．3±4．9） g/L vs．（11．0±4．7）g/L，t＝1．103，P＝0．274]和住院时间[（6．4±1．0）d vs．（6．2±1．0）d，t＝0．816，P＝0．417]均无统计学差异。并发症发生率如输血[8．3％（3/36） vs．6．5％（2/31），χ2＝0．000，P＝1．000]，发热[13.9％（5/36） vs．12．9％（4/31），χ2＝0．000，P＝1．000]，输尿管穿孔[0 vs．3．2％（1/31），P＝0．463]均无统计学差异。67例术后随访0．5～3年，平均1．2年，无肾功能丧失、肾周积液、复发性尿路感染、输尿管狭窄等。结论标准通道和微通道PCNL治疗输尿管上段结石的临床疗效与安全性无明显差别。%Objective To compare the efficacy of standard-tract and mini-tract percutaneous nephrolithotomy ( PCNL) in the management of upper ureteral stones . Methods We carried out a retrospective analysis on the clinical data of 67 patients with upper ureteral stones undergoing PCNL .The patients were divided into standard-tract PCNL group ( n=36) and mini-tract PCNL group (n=31).The operative time, postoperative stone clearance rate and complications of the two groups were compared . Results No significant differences were observed in the operative time [(42.3 ±8.9) min vs.(46.3 ±10.4) min, t=-1.697, P=0.095], first-stage stone clearance rate [97.2%(35/36) vs.93.5%(29/31),χ2 =0.018, P=0.894], hemoglobin drop values [(12.3 ± 4.9) g/L vs.(11.0 ±4.7) g/L, t=1.103, P=0.274] and hospital stay [(6.4 ±1.0) d vs.(6.2 ±1.0) d, t=0.816, P=0.417] between the two groups .No significant difference in the incidence of complications such as blood transfusion [8.3% (3/36) vs.6.5%(2/31),χ2 =0.000, P=1.000], fever [13.9% (5/36) vs.12.9% (4/31), χ2 =0.000, P=1.000] and ureter perforation [0 vs.3.2%(1/31), P=0.463] was found between the two groups .All the patients were followed up for 6 months to 3 years with a mean of 1.2 years and no kidney dysfunction , hydroperinephrosis , recurrent urinary tract infection or ureter stenosis was observed. Conclusion The efficacy and safety of standard-tract and mini-tract percutaneous nephrolithotomy in the management of upper ureteral stones are comparable .