摘要
目的比较体外冲击波碎石术(ESWL)、输尿管镜气压弹道碎石术(PL)、微创经皮肾取石术(MPCNL)及开放式输尿管切开取石术(UL)对上尿路结石的治疗效果,探讨上尿路结石的外科治疗方法。方法回顾性分析186例上尿路结石患者临床分类和治疗方法。本组单纯性肾结石34例,复杂性肾结石19例;输尿管上、中段结石79例,其中Ⅰ类结石12例,Ⅱ类结石44例,Ⅲ类结石23例;输尿管下段结石54例。结果本组行ESWL54例,PL103例,MPCNL11例,UL18例。术后2周,4组结石清除率分别为:ESWL组72.2%(39/54),PL组80.6%(83/103),MPCNL组81.8%(9/11),UL组100%(18/18)。结论ESWL适用于单纯性肾结石和位于输尿管上、中段的Ⅰ类输尿管结石;PL适用于输尿管下段结石;MPCNL适用于复杂性肾结石;UL可一次性取净结石,并同时处理输尿管狭窄等并发症。对于复杂性上尿路结石,需要多种方法联合使用才能达到最好的治疗效果。
Objective To compare the therapeutic effects of extracorporeal shock wave lithotripsy（ESWL）, pneumatic lithotripsy（PL）, minimally invasive percutaneous nephrolithotomy （MPCNL）, ureterolithotomy（UL）, and to explore and evaluate various surgical therapeutic methods for upper urinary tract calculi. Methods The data of 186 cases of upper urinary tract calculi were retrospectively reviewed. Of which,34 eases were pure kidney stones,19 cases were complicated kidney stones,79 cases were stones in the upper and middle segment ofureteral （12 group I ureteral stones,44 group Ⅱ ureteral stones and 23 group Ⅱ/ ureteral stones） and 54 cases were stones in the lower segment of ureteral. Result 54 cases were managed with ESWL,103 cases with PL,11 cases with MPCNL and 18 cases with UL.The stone free rates of the ESWL, PL, MPCNL and UL group 2 weeks after management were 72.2%（39/54）, 80.6%（83/103）, 81.8%（9/11） and 100%（18/18）, respectively. Conclusions ESWL has been the treatment of choice for pure kidney stones and for group I stones in the upper and middle segment of ureteral, PL has been the best for stones in the lower segment of ureteral, MPCNL has been the best for complicated kidney stones, and UL can remove stone at one time and treat complications such as ureteral stricture at the same time. For complicated upper urinary tract calculi, the best results of treatment can be achieved by unifying multiple methods.
出处
《中国医药指南》
2010年第10期13-15,共3页
Guide of China Medicine
关键词
尿路结石
治疗学
碎石术
外科手术
Urinary calculi
Therapeutics
Lithotripsy
Surgical procedures
