腹膜后腹腔镜与输尿管镜治疗输尿管上段嵌顿性结石的对比研究

Comparative study of retroperitoneal laparoscopy and ureteroscopy for impacted upper-ureteral calculi

目的:比较输尿管镜碎石术(ureteroscopic lithotripsy,URL)与腹膜后腹腔镜输尿管切开取石术(retroperitoneal laparoscopic ureterolithotomy,RLUL)治疗输尿管上段嵌顿性结石的有效性及安全性。方法:2006年8月至2010年5月收治56例单侧输尿管上段嵌顿性结石患者,34例用URL治疗,22例用RLUL治疗,比较两种术式一次性取石成功率和并发症发生率。结果:URL组中2例中转开放手术,3例因输尿管镜无法到达结石部位改行RLUL治疗成功,接受URL的29例中18例碎石不同程度上移,其中5例术后辅以体外冲击波碎石(extracorporeal shock wave lithotripsy,ESWL);一次性治疗成功率70.6%;RLUL组中1例因结石上移至肾盂改行ESWL,余21例均一次性清除结石,一次治疗成功率95.5%,术后漏尿1例。结论:RLUL具有患者创伤小、出血少、康复快、痛苦轻、并发症少、一次性取石成功率高等优点,可作为治疗嵌顿性输尿管上段结石的首选方法。

Objective：To compare the efficacy and security of ureteroscopic lithotripsy（URL） and retroperitoneal laparoscopic ureterolithotomy（RLUL） for impacted upper-ureteral calculi.Methods：From Aug.2006 to May 2010,34 cases（56 cases in total） of unilateral impacted upper-ureteral calculi accepted URL and the other 22 cases accepted RLUL.The success rate of one time treatment and the rate of complication occurrence of the 2 groups were compared.Results：Two cases in URL group were converted to open surgery,3 cases to RLUL because the ureteroscope could not reach the calculi.Calculi upper movement occurred in 18 cases of the 29 cases accepting URL,5 cases of which were treated with postoperative extracorporeal shock wave lithotripsy（ESWL）.The success rate of one time treatment was 70.6%.In RLUL group,1 case was converted to ESWL due to stones upper movement to renal pelvis,and calculi of the other 21 cases were successfully cleared,the success rate for one time treatment was 95.5%.1 case of urine leakage occurred after operation.Conclusions：RLUL has the advantages of small wound,little blood loss,early recovery,little pain,few complication and high one-time success rate,thus it can be adopted as the first choice for impacted upper-ureteral calculi.