URL治疗输尿管上段结石优势

输尿管上段嵌顿结石单纯输尿管镜VS联合PCNLURL治疗输尿管上段嵌顿结石的优势广东省中医院泌尿外科王树声教授URL是治疗输尿管上段嵌顿结石的首选

优势？劣势？疗效创伤并发症医学经济学效价两者治疗输尿管上段结石疗效相当URL一次性碎石成功率92.1%~94.4%，清石率98%~99.2%。PCNL清石率98%~100%。1.Gunlusoy

B,Degirmenci

T,ArslanM,etal.Ureteroscopicpneumaticlithotripsy:isthelocationofthestoneimportantindecisionmaking?Analysisof1296patients.JEndourol,2008(22)2:291-4.2.田溪泉，李建兴，邢念增等.输尿管镜下碎石清石术治疗输尿管上段结石[J].中国内镜杂志,2007(13)2:132-134.3.曾学明.钬激光治疗输尿管上段结石合并息肉38例[J].中国临床医学,2007(14)5:699-700.4.刘荣福，邢金春，王惠强等，钬激光腔内碎石治疗输尿管复杂性结石[J].中国医师进修杂志,2007(30)9:35-36,38.手术并发症URL显著低于PCNLURL总并发症发生率5～9％，严重并发症≤0.6～1％PCNL总并发症发生率38～41％，严重并发症≤5％1SunX,XiaS,LuJ,etal.Treatmentoflargeimpactedproximalureteralstones:randomizedcomparisonofpercutaneous

antegrade

ureterolithotripsyversusretrogradeureterolithotripsy.JEndourol,2008(22)5:913-7.2.JuanYS,ShenJT,LiCC,etal.Comparisonofpercutaneous

nephrolithotomyandureteroscopiclithotripsyinthemanagementofimpacted,large,proximalureteralstones.KaohsiungJMedSci,2008(24)4:204-9.PCNL手术并发症作者对PUBMED发表的超过1000例以上的PCNL文献复习报道总并发症最高达83％发热(21.0-32.1%)冲洗液外渗(7.2%)需要输血(11.2-17.5%)脓毒败血症(0.3-4.7%)结肠损伤(0.2-0.8%)胸膜损伤(0.0-3.1%)EurUrol.2007Apr;51(4):899-906医学经济学效价高URL手术时间平均26~42min，术后住院时间2.1~3.5天，平均费用0.6~0.8万元。PCNL手术时间平均75min，术后住院时间5~5.5天，平均费用1.5~2.0万元。1.SunX,XiaS,LuJ,etal.Treatmentoflargeimpactedproximalureteralstones:randomizedcomparisonofpercutaneous

antegrade

ureterolithotripsyversusretrogradeureterolithotripsy.JEndourol,2008(22)5:913-7.2.JuanYS,ShenJT,LiCC,etal.Comparisonofpercutaneous

nephrolithotomyandureteroscopiclithotripsyinthemanagementofimpacted,large,proximalureteralstones.KaohsiungJMedSci,2008(24)4:204-9.3.柳懿鹏,章传华,操作亮.输尿管镜下套石网篮配合钬激光碎石术治疗输尿管上段结石疗效观察[J].临床泌尿外科杂志,2008(23)11:840-841.4.朱凌峰,谭建明,吴卫真,等.输尿管镜下钬激光碎石术治疗输尿管结石（附96例报告）[J].中国内镜杂志,2007(13)6:640-642.手术技巧的提高和器械的改进

扩大了输尿管镜应用输尿管软镜配合套石网篮防止结石移位术中输尿管导管的应用防止结石移位钬激光超声负压碎石1.吴张鹏.输尿管镜气压弹道碎石术联合体外冲击波碎石术治疗输尿管结石[J].中国内镜杂志,2006(12)6:658-659.

2.柳懿鹏,章传华,操作亮.输尿管镜下套石网篮配合钬激光碎石术治疗输尿管上段结石疗效观察[J].临床泌尿外科杂志,2008(23)11:840-841.3.孙颖浩,王林辉,许传亮,等.末端可弯型输尿管镜治疗肾盏结石的初步体会[J].中华泌尿外科杂志,2005(26)11:743-745.

复杂输尿管结石同样效果满意输尿管结石伴息肉长段输尿管石街合并中、下段输尿管结石双侧输尿管结石1.CocuzzaM,ColomboJRJr,GanpuleA,etal.CombinedretrogradeflexibleureteroscopiclithotripsywithholmiumYAGlaserforrenalcalculiassociatedwithipsilateral

ureteralstones.JEndourol,2009(23)2:253-7.2.屠民琦,施国伟,何家扬.输尿管镜钬激光治疗输尿管结石伴息肉28例报告[J].临床泌尿外科杂志,2009(24)3:184-185.3.宋业平,张祖豹,何昶.经尿道输尿管镜下钬激光碎石术处理复杂输尿管结石[J].上海医学,2008(31)5:359-360.4.李中兴,魏雪栋,吴丹,等.输尿管镜下钬激光术处理长段输尿管石街[J].江苏医药,2008(34)6:626-627.5.孙颖浩,王林辉,许传亮,等.末端可弯型输尿管镜治疗肾盏结石的初步体会[J].中华泌尿外科杂志,2005(26)11:743-745.

6.柯维夫,蔡勤.经输尿管镜钬激光碎石术治疗复杂性输尿管结石[J].山东医药,2009(49)12:102-103.较大结石效果仍然满意直径＞2cm的输尿管上段结石亦可选择URL。首次碎石率达96.2%，给予辅助治疗后清石率达100%。ChenCS,WuCF,SheeJJ,etal.Holmium:YAGLasertripsywithsemirigid

ureterorenoseopeforupper—ureteralstones>2cm.JEndourol,2005,19(7):780-784，多发、多段输尿管结石更显本色输尿管上、中、下段结石URL清石率无显著性差异。结石的大小，位置对URL成功率无明显影响。1.LeijteJA,OddensJR,LockTM,etal.Holmiumlaserlithotripsyforureteralcalculi:predictivefactorsforcomplicationsandsuccess.JEndourol,2008(22)2:257-60.2.Gunlusoy

B,Degirmenci

T,ArslanM,etal.Ureteroscopicpneumaticlithotripsy:isthelocationofthestoneimportantindecisionmaking?Analysisof1296patients.JEn