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目的:评价上尿路结石不同治疗方法的疗效。方法:对采用5种不同治疗方法的211例上尿路结石患者的临床资料进行回顾性分析。结果:采用体外冲击波碎石术(ESWL)86例(41%),输尿管镜下气压弹道碎石术(URL)15例(7%),微创小切口开放手术15例(7%),开放手术辅助内镜取石术19例(9%),传统开放手术76例(36%)。ESWL治疗1个月后结石排净率为70%(60/86),2个月后结石排净率为77%(66/86),有3例发生输尿管石街,用URL或开放手术取净。URL对输尿管中下段结石取净率为100%,术中无输尿管穿孔、撕脱等并发症发生。微创小切口开放术结石取净率为87%,术中未输血。开放手术辅助内镜取石对肾结石的取净率为90%,术中未见肾皮质撕裂。传统开放手术结石取净率为86%,其中复杂性结石83%,术中术后输血7例(9%)。结论:上尿路结石可用腔内技术和ESWL治疗,微创小切口开放术、开放手术辅助内镜可提高复杂性结石的治愈率。
Objective: To evaluate the efficacy of different treatment of upper urinary tract stones. Methods: The clinical data of 211 patients with upper urinary tract calculi treated with 5 different treatments were retrospectively analyzed. Results: 86 cases (41%) of ESWL, 15 cases (7%) of ureteroscopic pneumatic lithotripsy (URL) and 15 cases (7%) of minimally invasive small incision open surgery Surgical assisted endoscopic lithotomy in 19 cases (9%), 76 cases of traditional open surgery (36%). Stone clearance rate was 70% (60/86) after 1 month of ESWL treatment, and stone clearance rate was 77% (66/86) after 2 months. There were 3 cases of ureteral stone street with URL or open surgery net. URL for the lower ureteral calculi take rate was 100%, intraoperative ureter perforation, avulsion and other complications occurred. Minimally invasive small incision open stone removal rate was 87%, intraoperative blood transfusions. Open surgery assisted endoscopic lithotomy fetus net rate of 90%, no renal cortex tear during surgery. Traditional open surgery stone removal rate was 86%, of which 83% of complex stones, intraoperative blood transfusion in 7 cases (9%). Conclusion: Upper urinary tract calculi can be treated with endovascular techniques and ESWL. Minimally invasive small incision open surgery and open surgery assisted endoscopy can improve the cure rate of complex stones.