后腹腔镜与输尿管镜治疗输尿管上段嵌顿结石的疗效比较

Comparison of efficacy with retroperitoneal laparoscopic and ureteroscopic in treatment on impacted upper ureteral stones

目的比较后腹腔镜与输尿管镜治疗输尿管上段嵌顿结石的疗效比较。方法选择70例单侧输尿管上段嵌顿结石,分别采用后腹腔镜输尿管切开取石术(腹腔镜组,34例)和经尿道输尿管镜碎石术(输尿管镜组,36例)。结果腹腔镜组的手术成功率明显高于输尿管镜组(P<0.05)。输尿管镜组的手术时间、术中出血量和术后住院时间均明显少于腹腔镜组(P<0.05或P<0.01)。腹腔镜组术后发生漏尿1例,输尿管镜组术后发生并发症8例,腹腔镜组术后并发症的发生率明显低于输尿管镜组(P<0.05)。腹腔镜组术后1个月结石清除率明显高于输尿管镜组(P<0.05)。结论后腹腔镜输尿管切开取石术手术成功率高,术后并发症少,结石清除率高,可作为治疗输尿管上段嵌顿结石首选术式。

Objective To compare the efficacy of treatment with retroperitoneal laparoscopic and ureteroscopic on impacted upper ureteral stones. Methods All of 70 cases of unilateral impacted upper ureteral stones were chosen, and retroperitoneal laparoseopic ureterolithotomy （laparoscopic group, 34 cases） and transurethral ureteroscopic lithotripsy （ureteroscopy group, 36 cases） were applied respectively. Results The success rate of laparoscopic surgery group was significantly higher than ureteroscopy group （P 〈 0.05）. The operation time, blood loss and postoperative hospital stay of ureteroscopy group were significantly less than the laparoscopic group （P 〈 0.05 or P 〈 0.01）. There was 1 case with laparoseopic postoperative urine leakage and 8 cases with postoperative complications in ureteroseopy group. The postoperative complications rate in the laparoscopic group was significantly lower than that in the ureteroseopy group （P 〈 0.05）. Stone clearance rate after 1 month in laparoseopic group was significantly higher than that in ureteroseopy group （P 〈 0.05）. Conclusion Laparoscopie ureterolithotomy has higher surgical success rate, fewer complications, higher stone clearance rate, and it can be the first choice in the treatment of impacted upper ureteral stones.