三种方法治疗直径大于1cm单发输尿管上段结石的比较研究

摘要

目的:比较体外冲击波碎石(SWL)、输尿管硬镜碎石(URL)和输尿管软镜碎石(FURL)治疗直径大于 1 cm 的单发输尿管上段结石的临床疗效.方法:回顾 2016 年 5 月~2017 年 12 月治疗的 124 例直径大于1 cm的单发输尿管上段结石患者的临床资料,采用 SWL 治疗患者 22 例,采用 URL治疗 59 例,采用 FURL 治疗 43 例.对三种方法治疗输尿管结石的一次性成功率、并发症发生率、视觉模拟疼痛评分、非预期急诊再入院率及治疗费用等各方面的差异进行比较.结果:SWL 的一次成功率27.3%,明显低于 URL和 FURL,并发症发生率高于 URL 和 FURL,差异有统计学意义(均P<0.05);URL在一次成功率、并发症发生率、非预期急诊再入院率等指标方面均好于 SWL;URL 并发症发生率与 FURL 差异无统计学意义(P>0.05);FURL 一次性成功率最高,为 95.3%,非预期再入院率最低,差异有统计学意义(均P<0.05),FURL的治疗费用则明显高于SWL和 URL(均P<0.05).结论:对于直径大于 1 cm 的单发输尿管上段结石,URL和 FURL都是较好的治疗方法,FURL 综合效果最佳,URL 结合使用拦截器,也是一种较好的方法,而 SWL应慎重采用.%Objective:To compare the effect of extracorporeal shock wave lithotripsy (SWL),ureteroscopic lithotripsy (URL)and flexible ureteroscopic lithotripsy (FURL)in the treatment of single larger than 1 cm in di-ameter calculus in upper ureter.Methods:From May 2016 to December 2017,124 cases of single larger than 1 cm in diameter calculus in upper ureter were treated in our hospital,including 22 cases given SWL,59 cases URL 59 and 43 cases FURL.The indexes of success rate of ureteral calculi,the incidence of complications,non-anticipated emergency readmission rate and treatment costs were compared.Results:The success rate of SWL was 27.3%, which was significantly lower than URL and FURL.The incidence of complications in SWL was significantly higher than that in URL and FURL (P<0.05 for both).The URL was better than SWL in terms of success rate,complication rate, unexpected emergency readmission rate and other indicators.There was no significant difference in the incidence of com-plications between URL and FURL (P>0.05).FURL had a maximum one-time success rate of 95.3%,with the lowest non-anticipated readmission rate and statistical significance (P< 0.05),while the treatment cost of FURL was signifi-cantly greater than that of SWL and URL (P<0.05).Conclusions:In comprehensive consideration for single larger than 1 cm in diameter calculus in upper ureter,FURL is the preferred treatment.Combined with the use of the interceptor, URL is also a kind of optimal method,while SWL should be carefully chosen.