嵌顿性输尿管上段结石的3种微创术式分析

Analysis of three treatment methods for impacted upper ureteral calculus

目的目前临床多选择微创手术治疗嵌顿性输尿管结石,如何正确评估与选择合适的术式,是一个值得探讨的问题。文中分析输尿管镜取石术（ureteroscopy lithotripsy,URL）、微创经皮肾穿刺取石术（minimally invasive percutaneous neph-rolithotripsy,MPCNL）、后腹腔镜输尿管切开取石术（retroperitoneoscopic ureterolithotomy,RPUL）3种不同微创手术方法治疗嵌顿性输尿管上段结石的临床应用和疗效。方法回顾性分析2004年8月至2009年11月我院收治的嵌顿性输尿管上段结石患者246例。年龄18-72岁,平均（42.1±11.1）岁。分为3组,A组：以URL术治疗120例;B组：以MPCNL术治疗85例;C组：以RPUL术治疗41例。比较其手术成功率、结石清除率、手术时间、术后住院时间、以及相关并发症的发生率。结果A、B、C 3组的成功率分别为95.8%、97.6%、95.1%,3组间无明显统计学差异（P=0.730）;结石清除率分别为70.8%、94.1%、92.7%,3组间有显著统计学差异（P〈0.01）,其中A组与B、C组相比有显著差异（P〈0.01）,B、C组间无明显差异（P=0.714）;平均手术时间分别为（25.2±7.6）min、（75.4±7.9）min、（148.7±10.1）min,3组间有显著统计学差异（P〈0.01）,两两比较均有明显差异（P〈0.01）;术后平均住院日分别为（5.2±2.2）d、（6.9±2.5）d、（9.6±2.6）d,3组间有显著统计学差异（P〈0.01）,两两比较均有明显差异（P〈0.01）;并发症发生分别为6.7%、4.7%、4.9%,3组间无明显统计学差异（P=0.930）。结论3种手术方式皆取得了较好的疗效,主要并发症的发生率大致相同,3种术式特点各有不同。临床实践时可根据医疗条件和患者病情作适当的选择。

Objective There are many choices in minimally invasive surgery for the treatment of impacted ureteral stones.How to properly evaluate and select the appropriate surgical method deserves further investigation.This article evaluated the application and clinical effects of ureteroscopic lithotripsy（URL）,minimally invasive percutaneous nephrolithotripsy（MPCNL） and retroperitoneoscopic ureterolithotomy（RPUL） in the treatment of impacted upper ureteral calculus.Methods We retrospectively analyzed 246 cases of impacted upper ureteral calculus treated in our hospital between August 2004 and November 2009.The patients,aged from 18 to 72（42.1±11.1） years,were assigned to groups A（n=120）,B（n=85） and C（n=41） to receive URL,MPCNL and RPUL,respectively.And we compared the three methods in the cure rate,the calculus elimination rate,postoperative hospital stay,and the rate of postoperative complications.Results The cure rates of groups A,B and C were 95.8%,97.6% and 95.1%,with no significant differences among the three（P=0.730）;the calculus elimination rates were 70.8%,94.1%,and 92.7%,with significant differences（P〈0.01）,significantly lower in group A than in B and C（P〈0.01）,but with no significant differences between the latter two（P=0.714）;the operating times were（25.2±7.6）,（75.4±7.9） and（148.7±10.1）minutes,with significant differences among the three and between any two as well（P〈0.01）;the postoperative hospital stays were（5.2±2.2）,（6.9±2.5） and（9.6±2.6） days,with significant difference among the three and between any two（P〈0.01）;the rates of postoperative complications were 6.7%,4.7% and 4.9%,with no significant differences among the three groups（P=0.930）.Conclusion All the three methods achieved good effects,with no significant differences in the rate of postoperative complications,but their characteristics vary from one another.A proper choice can be made among the three according to the condition of a specific patient.