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目的:比较经尿道输尿管镜钬激光碎石术(URL)和经皮肾镜取石术(PCNL)治疗复杂性输尿管上段结石的疗效。方法:125例复杂性输尿管上段结石患者按治疗方法分为两组:URL治疗60例,PCNL治疗65例。结果:URL组有5例转开放手术取石,余55例患者平均手术时间(59.45±16.30)min,术后并发症发生率为21.7%(13/60),3个月后结石清除率为90%(54/60)。PCNL组无中转,平均手术时间(61.38±12.90)min,术后并发症发生率为9.23%(6/65),3个月后结石清除率为100%。PCNL组的手术时间、术后住院时间与URL组无明显差异;1个月后结石清除率明显高于URL组。结论:PCNL治疗复杂性输尿管上段结石具有手术时间短、结石清除率高、术后并发症少及恢复快的优点。
Objective: To compare the efficacy of transurethral ureteroscopic holmium laser lithotripsy (URL) and percutaneous nephrolithotomy (PCNL) in the treatment of complex upper ureteral calculi. Methods: One hundred and twenty-five patients with complicated upper ureteral calculi were divided into two groups according to the treatment method: 60 cases were treated by URL and 65 cases were treated by PCNL. Results: Five patients underwent open surgery in the URL group. The average operative time in the remaining 55 patients was 59.45 ± 16.30 min. The postoperative complication rate was 21.7% (13/60). The stone clearance rate was 90% after 3 months % (54/60). The mean operative time (61.38 ± 12.90) min in PCNL group was 9.23% (6/65). The stone clearance rate was 100% after 3 months. The operation time and postoperative hospital stay in PCNL group were not significantly different from those in URL group. The stone clearance rate in PCNL group was significantly higher than that in URL group after 1 month. Conclusions: PCNL has the advantages of short operative time, high rate of stone removal, less postoperative complications and rapid recovery in the treatment of complex upper ureteral calculi.