输尿管上段结石腔镜手术治疗方法的应用分析

Application of endoscopic surgical treatments for upper urethral calculi

目的探讨各种微创腔镜方法治疗输尿管上段结石的适应证及优势。方法回顾分析316例输尿管上段结石患者,其中采用经尿道输尿管镜碎石术(URL)治疗76例,采用微创经皮肾镜取石术(mPCNL)治疗227例,采用后腹腔镜输尿管上段切开取石术(RPUL)13例,分析比较3种方法结石清除率。结果 URL治疗输尿管上段结石清除率为86.8%(66/76),其中第4腰椎横突(L4)以下结石清除率93.4%(43/46),URL治疗第4腰椎横突(L4)以上结石清除率76.7%(23/30),mPCNL治疗输尿管上段结石清除率为99.1%(225/227),RPUL一次结石清除率100%(13/13)。结论 3种方法均能有效地治疗输尿管上段结石,L4以下结石可首选URL治疗,L4以上结石可选用mPCNL治疗,长期较大嵌顿结石或输尿管上段结石合并同侧肾囊肿等可选用RPUL治疗。

【Objective】To explore indications and advantages of different methods of minimally invasive endo-scopic treatment of upper ureteral calculi.【Methods】316 patients with upper urethral calculi who underwent endo-scopic treatment were analyzed retrospectively.76 were treated using transurethral ureteroscope lithotripsy（URL）,227 were treated with minimally invasive percutaneous nephrolithotomy（mPCNL）,and 13 were treated with retroperitoneoscopic ureterolithotomy（RPUL）.【Results】The average stone clearance rate of URL for upper ureteral calculi was 86.8%（66/76）,with 93.4%（43/46） for calculi below the fourth lumbar transverse process（L4） and 76.7%（23/30） for calculi above the fourth lumbar transverse process（L4）.Stone clearance rate of mPCNL for upper urethral calculi was 99.1%（225/227）.Stone clearance rate of RPUL was 100%（13/13）.【Conclusions】All three methods can be effective in treating upper urethral calculi.URL is the first choice for stones below L4.mPCNL should usual-ly be the first choice for stones above L4.RPUL has advantages in patients with larger and long-term incarcerated stones or in patients with ipsilateral renal cyst.