嵌顿性输尿管上段结石两种微创术式的疗效比较

Comparison of two kinds of minimally invasive lithotripsy for treatment of impacted upper ureteric calculi

目的比较微创经皮肾穿刺取石术(MPCNL)和后腹腔镜输尿管切开取石术(RLUL)治疗嵌顿性输尿管上段结石的疗效。方法对144例单侧嵌顿性输尿管上段结石采用MPCNL(90例)或RLUL(54例)治疗,对比两组手术时间、结石清除率和术后高热(>38.5℃)率。结果 144例手术全部成功,手术时间MPCNL组短于RLUL组([43±9)min与(69±17)min,t=-11.564,P=0.000]。术后3 d血红蛋白下降MPCNL组显著高于RLUL组([0.59±0.30)g/L与(0.38±0.21)g/L(t=3.223,P=0.002)]。术后第2天结石清除率两组均为100%。术后高热率MPCNL组6.7%(6/90),与RLUL组5.6%(3/54)比较差异无显著性(χ2=0.000,P=1.000)。术后随访1～24个月,平均8个月,两组均未发现有输尿管狭窄和结石复发。结论 MPCNL和RLUL治疗输尿管上段嵌顿性结石均是安全、有效的,两者均可以选用。

【Objective】 To compare the therapeutic effects of minimally invasive precutaneous nephrolithotomy（MPCNL） and retroperitoneal laparoscop in ureterolithotomy（RLUL） in the management of impacted upper ureteral calculi.【Methods】 A total of 144 patients with unilateral impacted upper ureteral calculi were treated with MPCNL（n=90） or RLUL（n=54）.The operation time,clearance rate of the stone,and the incidence of postoperative hyperpyrexia were statistically analyzed.【Results】 All the operations were completed.As compared to the RLUL group,the MPCNL group had a significant shorter operation time [（43±9） minutes vs（69±17） minutes,t=-11.564,P =0.000].As compared with the RLUL group,the MPCNL Group showed a significantly reduction of mean blood hemoglobin concentration on the third day after the operations [MPCNL group：（0.59±0.30） g/L vs RLUL group：（0.38±0.21） g/L,t=3.223,P =0.002].On the day after the operation,both the group s showed a stone clearance rate of 100%.No significant difference was detected in the rate of postoperative hyperpyrexia between the two groups [6.7%（6/90） vs 5.6%（3/54）,χ2=0.000,P =1.000].The patients were followed up 1 to 24 months（mean,8 months）,none of them developed ureteral stricture or recurrent stones during the period.【Conclusion】 Both MPCNL and RLUL are safe,effective and feasible for impacted upper ureteral calculi.