摘要
目的：逆行经尿道输尿管取石术（URL）与顺行经皮肾微造瘘输尿管取石术（MPCNL）均广泛应用于治疗输尿管结石。为探讨两种方法的适应证,文内比较逆行与顺行输尿管镜术处理合并感染的输尿管上段结石的疗效、安全性及对机体的损伤程度。方法：采用输尿管镜术治疗合并感染的输尿管上段结石192例,其中逆行经尿道入路治疗72例,顺行经皮肾微造瘘入路120例。结果：逆行经尿道入路手术成功67例（93.1%）,平均手术时间45.9±16.5 min（20~90 min）,平均住院时间5.1±1.8 d（2~6 d）,CRP术前为10.59±5.12 mg/L,术后24 h为38.63±4.61 mg/L。术后1个月复查无石率为84.7%（61/72）,发生手术并发症者4例（5.6%）。顺行输尿管镜入路手术成功119例（99.2%）,平均手术时间62.4±17.6 min（40~120 min）,平均住院时间8.6±2.6 d（5~15 d）,CRP术前为11.29±5.38 mg/L,术后24 h为34.93±7.82 mg/L。术后1个月复查无石率100%（120/120）,发生手术并发症者1例（0.8%）。经统计学处理,顺行经皮肾微造瘘组的手术成功率及无石率均较逆行经尿道组高（P〈0.05）,并发症低（P〈0.05）,但平均手术时间及住院时间长（P〈0.05）。2组患者术前血清CRP含量无差异（P〉0.05）,术后24 h CRP有显著差异（P〈0.05）,顺行组发生手术并发症者明显少于逆行组。结论：逆行与顺行输尿管镜术处理合并感染的输尿管上段结石均有较高的手术成功率与术后无石率,顺行入路的安全性与有效性更好。
Objective ： Both URL and MPCNL have been widely applied in the treatment of ureteral cal- culi. In this study, the safety, efficiency and degree of injury were compared between retrograde and an- tegrade access ureterolithotripsy for the calculi complicated with infection, in order to clarify the indica- tions of the two types of minimally invasive techniques. Methods ： A total of 192 patients with upper ure-teral calculi complicated with infection were treated with ureterolithotripsy. The operation was performed via retrograde transurethral access in 72 patients and via antegrade percutaneous nephrostomy tract in 120 patients. Results：The success rate of retrograde approach was 93. 1% . Mean operating time was 45.9±16.5min（20 -90 min） with mean hospital stay of 5.1±1.8（2-6） days. The stone free rate was 84.7% （61/72） at 1 month follow -up. 5 patients with residual calculi required combined ESWL. Com- plications were noted in 5.6%, CRP was 10.59 ± 5.12 mg/L before operation, and was 38.63 ± 4.61 mg/L 24h after the operation. The success rate of antegrade approach was 99.2% . Mean operating time was 62.4 ± 17.6 min（40- 120 min） with mean hospital stay of 8.57±2.57（5 -15 ） days. The stone free rate was 100% and 1 complication was noted（0.01% ）. CRP was 11.29±5.38 mg/L before the operation, 34.93 ±7.82 mg/L 24h after the operation. For the success rate and stone free rate, ante- grade approach was higher than retrograde approach （ P 〈 0.05 ）, and the complication rate was lower （ P 〈 0.05 ）, but the mean operating time was long. CRP was not different （ P 〉 0.05 ） between the two groups before operation, but antegrade approach had lower CRP （ P 〈 0.05 ） after the operation. Con- clusion ： Retrograde and antegrade ureterolithotripsy were safe and effective for upper ureteral calculi with infection. Success rate and stone free rate was higher in the antegrade approach than those of the retro- grade approach.
出处
《医学研究生学报》
CAS
2009年第6期620-623,共4页
Journal of Medical Postgraduates
基金
广东省东莞市自然科学基金资助项目(批准号:200676)
关键词
输尿管结石
输尿管镜术
逆行经尿道入路
顺行经皮肾微造瘘
Calculus
Ureteroscopy
Retrograde transurethral access
Antegrade percutaneous nephrostomy tract
