Sun Xiaowen, Xia Shujie, Lu Jun, Liu Haitao, Han Bangmin, Li Weiguo
The Affiliated First People's Hospital of Shanghai Jiaotong University, Department of Urology, Shanghai, Shanghai, China.
J Endourol. 2008 May;22(5):913-7. doi: 10.1089/end.2007.0230.
We compared the safety and efficacy of percutaneous antegrade ureterolithotripsy with retrograde ureterolithotripsy for large impacted proximal ureter stones in a prospective randomized manner.
A total of 91 patients with large impacted proximal ureteral stones, defined as stones >1 cm in size located between the ureteropelvic junction and the lower border of the fourth lumbar vertebra, were prospectively randomized for antegrade (44) or retrograde (47) ureterolithotripsy. Failure of the procedure (conversion to an open procedure), intraoperative and postoperative morbidity, operative time, hospital stay, stone clearance at discharge home, and follow-up were analyzed in each group.
The main complications were bleeding (2.3%; 1 of 43) for the antegrade procedure and ureteral injury (2.3%; 1 of 44) for the retrograde procedure. Percutaneous antegrade ureterolithotripsy was associated with longer operative times (75.4+/-11.8 v 30.6+/-7.8 minutes; P<0.001), longer hospital stay (6.3+/-0.5 v 2.1+/-0.4 days; P<0.001), and a longer interval to return to normal activities (7.8+/-0.7 v 2.7+/-0.6 days; P<0.001). Nevertheless, the percutaneous antegrade procedure had a higher stone-free rate both at discharge home (95.3% v 79.5%; P=0.027), and 1 month post-procedure (100% v 86.4%; P=0.026).
Percutaneous antegrade ureterolithotripsy is a valuable treatment modality for impacted proximal ureteral calculi larger than 1 cm, and achieves higher stone-free rates than those of retrograde ureteroscopy with holmium:YAG laser lithotripsy. The drawbacks of the antegrade procedure are longer operative time and hospital stay.
我们以前瞻性随机方式比较了经皮顺行输尿管碎石术与逆行输尿管碎石术治疗大型嵌顿性近端输尿管结石的安全性和有效性。
共有91例大型嵌顿性近端输尿管结石患者，定义为位于输尿管肾盂连接处与第四腰椎下缘之间、大小>1 cm的结石，被前瞻性随机分为顺行（44例）或逆行（47例）输尿管碎石术组。分析每组手术失败（转为开放手术）、术中和术后发病率、手术时间、住院时间、出院时结石清除情况及随访情况。
主要并发症为顺行手术组出血（2.3%；43例中的1例）和逆行手术组输尿管损伤（2.3%；44例中的1例）。经皮顺行输尿管碎石术的手术时间更长（75.4±11.8对30.6±7.8分钟；P<0.001）、住院时间更长（6.3±0.5对2.1±0.4天；P<0.001）以及恢复正常活动的间隔时间更长（7.8±0.7对2.7±0.6天；P<0.001）。然而，经皮顺行手术在出院时（95.3%对79.5%；P=0.027）和术后1个月（第100%对86.4%；P=0.026）的结石清除率更高。
经皮顺行输尿管碎石术是治疗大于1 cm的嵌顿性近端输尿管结石的一种有价值的治疗方式，并且比钬：YAG激光碎石术的逆行输尿管镜检查具有更高的结石清除率。顺行手术的缺点是手术时间和住院时间更长。
