无管化微创经皮肾镜与后腹腔镜治疗长径≥1cm嵌顿性输尿管上段结石的比较

Comparison of tubeless-percutaneous nephrolithotomy and retroperitoneal laparoscopic ureterolithotomy in the treatment of incarcerated upper-ureteral calculi sized ≥1cm

目的:比较无管化微创经皮肾镜取石术(mPCNL)与后腹腔镜输尿管切开取石术(RLU)治疗≥1 cm嵌顿性输尿管上段结石的临床疗效及安全性。方法:回顾性分析56例嵌顿性输尿管上段结石患者的临床资料,按手术治疗方法分为无管化mPCNL组33例和RLU组23例,比较两组的手术时间、手术成功率、结石清除率、术后住院天数及并发症发生率。结果:两组患者手术时间、术后住院天数、血红蛋白下降量等差异有统计学意义(P<0.05),而手术成功率、结石清除率、术后发热等并发症发生率差异无统计学意义(P>0.05)。mPCNL组1例患者因术中通道出血明显留置肾造瘘管,术后有2例活动性出血,经卧床休息及药物止血治疗后好转。RLU组1例术中结石上移至肾内导致手术失败,中转开放取石处理。结论:mPCNL和RLU对治疗嵌顿性输尿管上段大结石均有满意的手术成功率和结石清除率,但mPCNL组手术时间更短,对患者创伤更小,术后住院时间更短,因此对于嵌顿性输尿管上段结石患者,行无管化mPCNL更优。

Objective To compare the efficacy and safety of tubeless mini-invasive percutaneous nephrolithotomy(mPCNL)and retroperitoneal laparoscopic ureterolithotomy(RLU)for the treatment of incarcerated upper-ureteral stones(≥1 cm in size).Methods:Fifty-six patients with incarcerated upper-ureteral calculi(≥1 cm in size),which were divided into mPCNL group(33 cases)and RLU group(23 cases)respectively,were included in the retrospective investigation.The operative time,the intraoperative blood loss(hemoglobin reduction),the operation success rate,the stone clearance rate,the postoperative hospital stay and the incidence of complications were compared.Results:There were significant differences in operative time,hospitalization days and hemoglobin decrease between the two groups(P<0.05),but there were no significant differences in operation success rate,stone clearance rate and fever after operation(P>0.05).In mPCNL group,one patient had retained a nephrostomy tube because of obvious bleeding from the percutaneous way.Active postoperative bleeding happened in two cases,which was recovered after medication treatment.In RLU group,the stone of one case moved up into the kidney cavity during operation and the procedure was converted to open surgery.Conclusions:Both mPCNL and RLU have satisfactory success rate and stone clearance rate for the treatment of large incarcerated upper-ureteral calculi.However,the operative time in mPCNL group is shorter,the trauma is milder,and the postoperative hospital stay is shorter too.Therefore,we think that the patients with incarcerated upper ureteral calculi are more suitable for the treatment of tubeless MPCNL.