微创经皮肾穿刺取石术和后腹腔镜下输尿管切开取石术治疗嵌顿性输尿管上段结石的疗效比较

Comparison of Minimally Invasive Percutaneous Nephrolithotomy and Retroperitoneal Laparoscopic Ureterolithotomy for Impacted Upper Ureteral Calculi

目的比较微创经皮肾穿刺取石术（minimally invasive percutaneous nephrolithotomy，MPCNL）和后腹腔镜输尿管切开取石术（retroperitoneal laparoscopic ureterolithotomy，RLUL）治疗嵌顿性输尿管上段结石的疗效。方法对72例单侧嵌顿性输尿管上段结石采用MPCNL（45例）或RLUL（27例）治疗，对比2组手术时间、结石清除率和术后高热（〉38．5℃）率。结果72例手术全部成功，手术时间MPCNL组短于RLUL组[（43±9）min与（69±17）min，t=-11．564，P=0．000]。术后第2天结石清除率2组均为100％。术后高热率MPCNL组13．3％（6／45），与RLUL组11．1％（3／27）比较差异无显著性（Χ^2=0．000，P=1．000）。术后随访1～24个月，平均8个月，2组均未发现有输尿管狭窄和结石复发。结论MPCNL和RLUL治疗输尿管上段嵌顿性结石均是安全、有效的，两者均可以选用。

Objective To compare the therapeutic effects of minimally invasive percutaneous nephrolithotomy （MPCNL） and retroperitoneal laparoscopie ureterolithotomy （RLUL） in the management of impacted upper ureteral calculi. Methods A total of 72 patients with unilateral impacted upper ureteral calculi were treated with MPCNL （n = 45 ） or RLUL （n = 27 ）. The operation time, clearance rate of the stone, and the incidence of postoperative hyperpyrexia were statistically analyzed. Results All the operations were completed. As compared to the RLUL group, the MPCNL group had a significant shorter operation time [ （43 ±9） minutes vs （69± 17） minutes, t = - 11. 564, P = 0. 000]. On the day after the operation, both the groups showed a stone clearanee rate of 100%. No significant difference was detected in the rate of postoperative hyperpyrexia between the two groups [ 13.3% （6/45） vs 11.1%（3/27）,）（2 =0.000, P = 1.000）. The patients were followed up for 1 to 24 months （mean, 8 months）, none of them developed ureteral stricture or recurrent stones during the period. Conclusion Both MPCNL and RLUL are safe, effective, and feasible for impacted upper ureteral calculi.