目的 比较两种内镜应用于治疗输尿管上段结石伴肾盂中重度积水的效果。方法 输尿管上段结石患者伴肾盂中重度积水60例,随机分成两组,经皮输尿管软镜组(软镜组)和经皮输尿管硬镜组(硬镜组),每组30例。选择第11~12肋间或第12肋下,肩胛下和腋后线间范围为穿刺点,在B超引导下穿刺进入目标肾盏:软镜组用输尿管软镜经peel-away鞘顺行法寻找到肾盂进入输尿管,寻找到结石后用钬激光碎石;硬镜组用输尿管硬镜按上述方法寻找输尿管结石并碎石。结果 软镜组结石排净率93.3% (28/30),硬镜组70.0% (21/30),两组比较,差异有统计学意义(χ²=5.45,P=0.0195)。软镜组手术时间(67±15)min,硬镜组(51±13)min,差异有统计学意义(t=2.35,P=0.0250)。术后软镜组2例(6.7%)发热,硬镜组3例(10.0%)发热,两组比较差异无统计学意义。结论 合并肾盂中重度积水的上尿路结石,采用经皮肾输尿管软镜顺行碎石,虽然时间长于硬镜组,但结石取净率高。

Objective To compare two endoscopies used in upper ureteral calculi with moderate and severe hydronephrosis in renal pelvis. Methods Sixty patients with upper ureteral calculi complicated by middle-high grade nephrohydrops were randomly divided into two groups, the percutaneous flexible ureteroscopy group (flexible ureteroscopy group) and the percutaneous rigid ureteroscopy group (rigid ureteroscopy group), 30 patients in each group. The range between infrascapular line and postaxillary line under the eleventh or twelfth rib were as puncture point, and then the target renal calculi were seeked under the ultrasound guidance. In flexible ureteroscopy group, the renal calculi and ureter were seeked by flexible ureteroscopy through the peel-away sheath anterograde mehtod, and then holmium laser lithotripsy was performed for the ureteral calculi. In rigid ureteroscopy group,the seeking procedures were performed by rigid ureteroscopy, and the method was the same as the flexible ureteroscopy group. Results In flexible ureteroscopy group, the lithagogue rate was 93.3% (28/30), that in rigid ureteroscopy group was 70% (21/30), the former was higher than the latter, the difference was statistically significant(χ²=5.45,P=0.0195). In flexible ureteroscopy group, the operation time was (67±15) min, in rigid ureteroscopy group (51±13) min, the difference was statistically significant (t=2.35,P=0.0250). Two patients in flexible ureteroscopy group (6.7%) had fever after surgery, three patients in rigid ureteroscopy group (10%) had fever, the difference between the two groups was not statistically significant. Conclusions There were fewer complications and higher stone free-rates in the patients with upper ureteral calculi complicated by middle-high grade nephrohydrops, by using percutaneous anterograde flexible lithotripsy.