上尿路结石五种微创手术的临床比较分析

Clinical comparative study of five minimally invasive surgeries for upper urinary tract calculi

目的比较逆行输尿管硬镜碎石术（URSnf）、逆行输尿管软镜碎石术（URSf）、经皮肾镜取石术（Percutaneous nephrolithotomy, PCNL）、前腹腔镜取石术及后腹腔镜取石术的疗效，探讨复杂性上尿路结石的最佳治疗术式和其适应证。方法总结分析浙江省绍兴县中心医院2005年1月至2008年12月问手术治疗的1071例上尿路结石患者的5种微创手术的疗效，其中输尿管结石964例，。肾结石94例，输尿管合并。肾结石并同时手术处理13例；其中URSnf术869例，URSf术56例，MPCNL术57例，前腹腔镜取石术9例，后腹腔镜取石术80例。结果URSnf术856例成功（98．50％）；URSf术51例（91．07％）成功；MPCNL术46例（80．70％）成功；前腹腔镜取石术9例（100％）全部成功；后腹腔镜取石术75例（93．75％）成功；全组5例（0．74％）失败，无严重并发症。结论掌握各术式的适应证，5种微创手术方法处理复杂性上尿路结石，高效安全。

Objective To compare the efficacy of minimally invasive percutaneous nephrolithotomy （PCNL）, ureteroseopes supple of lens of lithotrity （URSf）, ureter forcedly of lens of lithotrity （ URSnf）, laparoscopic ureterolithotomy and retropefitoneal laparoseopic ureterolithotomy and to explore the best methods and indications for treating the complex upper urinary tract calculi. Methods The distribution of cases was as follows ： URSnf （ n = 869）, URSf （ n = 56）, MPCNL （ n = 57 ）, laparoscopic ureterolithotomy （n = 9 ） and retroperitoneal laparoscopic ureterolithotomy （n = 80）. Results A successful outcome was obtained in URSnf （ n = 856 ）, URSf （ n = 51 ）, MPCNL （ n = 46 ）, laparoscopic ureterolithotomy （ n = 9 ） and retroperitoneal laparoscopie ureterolithotomy （ n = 75 ）. And the success rate was 98.50% , 91.07% , 80. 70%, 100% and 93.75% respectively. Five cases （0. 47% ） failed and there were not severe complication in all surgery groups. Conclusion If a good indication of each approach is mastered, 5 minimally invasive are relatively safe and highly effective for most patients with complex upper urinary tract calculi.