三种微创术式治疗嵌顿性输尿管上段结石的疗效比较

Comparative Study of Three Kinds of Minimally Invasive Lithotripsy for Treatment of Impacted Upper Ureteric Calculi

目的比较经尿道输尿管镜碎石术(URL)、微创经皮肾穿刺取石术(MPCNL)及后腹腔镜输尿管切开取石术(RPLU)治疗嵌顿性输尿管上段结石的疗效和安全性。方法对116例单侧嵌顿性输尿管上段结石患者分别采用URL、MPCNL及RPLU治疗,比较三组的手术时间、术后住院天数、并发症、术后3d及1个月的结石清除率等。结果三组间手术时间比较均有极显著性差异(MPCNL组<URL组<RPLU组,均P<0.01)。三组间并发症比较无统计学意义(P>0.05)。三组间术后住院天数比较有显著性差异(RPLU组<URL组<MPCNL组,P<0.01和P<0.05)。MPCNL组及RPLU组在术后需ESWL治疗的例数、术后3d及术后1个月的结石清除率均优于URL组(P<0.01和P<0.05),但MPCNL组与RPLU组比较无统计学意义(P>0.05)。结论对于输尿管上段嵌顿结石,如肾积水较明显且结石位置接近肾盂者更适合MPCNL治疗;结石较小或位置较低、患者主动要求并能接受术后辅助措施如ESWL者可选择URL;对采用MPCNL或URL治疗难度大,或经ESWL、URL、MPCNL治疗失败的病例可选择RPLU。

Objective To compare the efficacy and safety of transurethral ureteroscope lithotripsy（URL）,the minimally invasive percutaneous nephrolithotomy（MPCNL） and retroperitoneal laparoscopic ureterolithotomy（RPLU） in treating impacted upper ureteric calculi.Methods 116 patients with impacted upper ureteric calculi were treated with URL,MPCNL and RPLU respectively.The operating time,postoperative hospital staying time,complications and postoperative stone clearance rate in 3 days and one month of three groups were compared and analyzed.Results There was statistical significance of the operation time in the three groups（MPCNL group URL group RPLU group,all P〈0.01）.There was no statistical significance of the operation related complications in the three groups（P〈0.05）.There was statistical significance of the postoperative hospital stay time in the three groups（RPLU group URL group MPCNL group,P〈0.01 or P〈0.05）.In comparison of the rate of needing treatment of extracorporeal shock wave lithotripsy（ESWL）,the stone free rate in 3 days and one month postoperation,MPCNL group or RPLU group was better than URL group（P〈0.01 or P〈0.05）,but there was no statistical significance between MPCNL group and RPLU group（all P〈0.05）.Conclusions MPCNL may be the better choice for impacted upper ureteric calculi which is larger,higher and follows obvious hydronephrosis.URL is better for the patients whose ureteric calculi is smaller,lower or the patients who claim to accept postoperative ESWL.RPLU is suitable for patients with impacted upper ureteric calculi who are difficult for MPCNL or URL,and as a salvage procedure after failed ESWL,URL or MPCNL.