微创经皮肾镜与后腹腔镜治疗嵌顿性输尿管上段结石的比较研究

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

目的比较微创经皮肾镜取石术(minimally invasive percutaneous nephrolithotomy,MPCNL)与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有效性及安全性。方法2003年9月～2008年6月,对73例伴有肾积水的单侧嵌顿性输尿管上段结石,46例采用MPCNL治疗(MPCNL组),27例采用RLUL治疗(RLUL组),比较2组的结石清除率及手术并发症。结果RLUL组手术时间为(92.6±23.3)min,显著长于MPCNL组的(66.7±20.3)min(t=-4.967,P=0.000)。术后3d的结石清除率MPCNL组为93.5%(43/46),RLUL组为100.0%(27/27),差异无显著性(χ2=0.554,P=0.457)。术后3d血红蛋白下降MPCNL组为(0.59±0.30)g/L,显著高于RLUL组的(0.38±0.21)g/L(t=3.223,P=0.002)。术后MPCNL组有4例(8.7%)出现38.5℃以上发热,与RLUL组1例(3.7%)差异无显著性(χ2=0.112,P=0.737)。术后RLUL组有1例(3.7%)尿漏,与MPCNL组(0/46)差异无显著性(χ2=0.074,P=0.786)。结论MPCNL与RLUL在治疗嵌顿性输尿管上段结石上都具有满意的疗效与安全性,RLUL术中出血较少,但手术时间长,在有条件且技术成熟的医院可适当开展。

Objective To compare the efficacy and safety of minimally invasive percutaneous nephrolithotomy （MPCNL） and retroperitoneal laparoscopic ureterolithotomy （RLUL） for impacted upper ureteral calculi. Methods From September 2003 to June 2008, a total of 73 patients with unilateral impacted upper ureteral calculi complicated with hydronephrosis were treated in our hospital. Among the patients, 46 patients received MPCNL （MPCNL Group） , and the other 27 patients underwent RLUL （RLUL Group）. The rates of stone clearance and operative complications were analyzed. Results The mean operation time in RLUL group was （92.6 ± 23.3 ） min, which was significantly longer than that of MPCNL group [ （66.7 ± 20.3 ） min, t = - 4. 967, P = 0. 000）. On the day 3 after the surgery, no marked difference was detected in the stone clearance rate between the two groups [ MPCNL group： 93.5% （43/46） vs RLUL Group： 100.0% （27/27）;χ2 = 0. 554, P = 0. 457]. As compared with the RLUL Group, the MPCNL Group showed a significantly reduction of mean blood hemoglobin concentration on the third day after the operations [ MPCNL group： （0.59 ± 0.30） g/L vs RLUL group： （0.38 ± 0.21 ） g/L, t = 3. 223, P = 0. 002）. The incidences of postoperative hyperpyrexia （ T 〉 38.5 ℃） and urine leakage were similar between the two groups [8.7% （4/46） vs 3.7% （1/27）,χ2 =0.112, P=0.737; and 0 （0/46） vs 3.7% （1/27）, χ2 = 0. 074, P = 0. 786 ]. Conclusions Both MPCNL and RLUL are effective and safe for impacted upper ureteral calculi. RLUL, which results in less blood loss but longer operation time, is feasible in advanced hospitals.