输尿管镜与后腹腔镜手术治疗输尿管上段结石的疗效比较

Comparative study on ureteroscopic lithotripsy and laparoscopic ureterolithotomy for the treatment of unilateral upper ureteral stones

目的比较输尿管镜碎石取石术与后腹腔镜输尿管切开取石术治疗单侧输尿管上段结石的疗效,探讨两种术式的适应证及技术要点。方法收治64例单侧输尿管上段结石患者,随机分成两组,32例行腰硬麻下输尿管镜钬激光碎石取石术,32例行气管全麻下后腹腔镜输尿管切开取石术,两组术中均留置双J管,比较两组的手术时间、术后住院时间、结石清除率及手术并发症。结果两组手术均取得成功,无一例中转开放手术。输尿管镜组与后腹腔镜组的平均手术时间为51.0±10.8 minVS 43.8±8.1 min(t=3.02,P=0.0037),住院时间为3.0±1.3 d VS 3.1±0.9 d(t=-0.36,P=0.7217),一次手术结石清除率为87.5%(28/32)VS 100%(32/32),输尿管镜组术中4例发生结石上移,术后配合ESWL清除结石。两组术后随访3个月以上,未见输尿管狭窄等并发症。结论对于单侧输尿管上段结石,后腹腔镜输尿管切开取石术较输尿管镜碎石取石术一次手术结石清除率高,手术时间短,是一种安全、有效的方法。

Objective To compare the curative effects of ureteroscopic lithotripsy and laparoscopic ureterolithotomy for unilateral upper ureteral stones, and to explore optimal surgical indications and skills. Methods Sixty-four cases of unilateral upper ureteral stones were randomly divided into two groups： one group underwent ureteroscopic holmium laser lithotripsy under epidural or lumbar anesthesia （n=32）, the other group underwent laparoscopic ureterolithotomy under general anesthesia （n=32）. Double-J stent was routinely indwelled in both groups. Operating time, postoperative hospitalization time, stone clearance rate and perioperative complications were compared. Results All of the operations were successfully performed, and no open surgery was converted. In the ureteroscopy and laparoscopy groups, the mean operating time was 51.0±10.8 rain and 43.8±8.1 min （t=3.02, P=- 0.0037）, respectively; the hospitalization time was 3.0±1.3 days vs 3.1±0.9 days （t=-0.36, P=0.7217）; the stone clearance rate was 87.5% （28/32） vs 100% （32/32）. Stone moved to the renal pelvis in 4 eases of the ureteroscopy group, and residual stones were removed by extracorporeal shock-wave litbotripsy（ESWL）. All patients were followed up for more than 3 months, and no serious complications such as ureterostenosis occurred. Conclusions Laparoscopic ureterolithotomy has a higher stone clearance rate and shorter operation time compared with ureteroscopic lithotripsy. Laparoscopic ureterolithotomy is a safe and effective therapeutic method for unilateral upper uretersl stones.