施健　楼雨蛟　张青川

[摘要] 目的 对照分析体外冲击碎石（ESWL）、输尿管镜超声碎石（URL）、经皮肾镜取石（MPCNL）三种方法治疗输尿管上段结石的临床效果。 方法 随机选取2012年12月～2013年12月上海市中医药大学附属普陀医院诊治的输尿管上段结石患者126例，依据其选择的手术方式分为三组，38例行ESWL术的患者作为对照组，42例行URL术的患者作为研究A组，46例行MPCNL术的患者作为研究B组，分析三种方式的近期疗效、围术期情况及安全性。 结果 三组患者的手术时间及术后并发症发生率比较，差异无统计学意义（P > 0.05）；研究B组患者的一次碎石成功率（100.00%）与结石清除率（100.00%）均高于对照组（63.16%、55.26%）及研究A组（80.95%、73.81%），差异均有统计学意义（P < 0.05）；对照组多次碎石成功率高于研究A组及研究B组，差异均有统计学意义（P < 0.05）；研究B组患者的住院时间及治疗费用高于对照组与研究A组，差异均有统计学意义（P < 0.05）。 结论 MPCNL术治疗输尿管上段结石的临床效果显著，具有临床推广与应用价值。

[关键词] 体外冲击碎石；输尿管镜超声碎石；经皮肾镜取石；输尿管上段结石

[中图分类号] R691.4 [文献标识码] A [文章编号] 1673-7210（2015）05（c）-0070-04

[Abstract] Objective To contrast analyze clinical effect of three methods， such as extracorporeal shock wave lithotripsy （ESWL）， ureter mirror ultrasonic lithotripsy （URL）， microinvasive percutaneous nephrolithotomy with lithotomy （MPCNL） in the treatment of upper ureteral calculi. Methods 126 patients from December 2012 to December 2013 who were diagnosed and treated by upper ureteral calculi in the Affiliated Putoff Hospital of Shanghai Chinese Medical University were randomly selected， and they were divided into three groups according to the surgical procedures， 38 patients who were treated by ESWL were as control group， 42 patients with URL were experiment group A， 46 patients with MPCNL were experiment group B. The short-term curative effects of three ways were analyzed， cooperative data and security conditions were also analyzed. Results The operation time and postoperative complication rates of three groups had no statistical significance （P > 0.05）； gravel success rate of patients in the experiment group B was 100.00% and calculi clearance rate was 100.00%， the control group were 63.16% and 55.26%， the experiment group A were 80.95% and 73.81%， experiment group B was higher than those of the control group and experiment group A， the differences were statistically significant （P < 0.05）； multiple gravel success rate of the control group was higher than those of the experiment group A， B， the differences were statistically significant （P < 0.05）； patient's hospital time and cost of treatment in the experiment group B were higher than those of the control group and experiment group A， the differences were statistically significant （P < 0.05）. Conclusion MPCNL is a significantly clinical curative effect in the treatment of upper ureteral calculi， it has value of clinical popularization and application.

[Key words] Impact rubble in Nitro； Deuteroscopic ultrasonic lithotripsy； Percutaneous nephoscope lithotomy； Upper ureteral calculi

输尿管上段结石作为泌尿外科临床常见多发性疾病，手术是其主要治疗方案，早期常用的开放性手术，疗效较佳，但由于其创伤性较大、术后恢复时间长等局限性，较难在临床中普及使用。随着内镜与微创技术的进步，体外冲击碎石（extracorporeal shock wave lithotripsy，ESWL）、输尿管镜超声碎石（ureter mirror ultrasonic lithotripsy，URL）以及经皮肾镜取石（microinvasive percutaneous nephrolithotomy with lithotomy，MPCNL）已成为输尿管结石的主要治疗手段[1-2]。针对无法通过保守治疗排除输尿管上段结石患者，临床多采用ESWL治疗，但对于复杂性输尿管上段结石患者该术式疗效不甚理想，通常采用URL和MPCNL两种术式治疗，且疗效均得到相关专家学者的认可。本研究对上海市中医药大学附属普陀医院（以下简称“我院”）诊治的12……