后腹腔镜下输尿管切开取石术与输尿管镜下气压弹道碎石术治疗嵌顿性较大输尿管上段结石的比较

Comparison of Retroperitoneal Laparoscopic Ureterolithotomy(RLUL)and Pneumatic Lithotripsy(PL)on Larger Impacted Upper-ureteral Calculi

目的比较后腹腔镜下输尿管切开取石术(RLUL)与输尿管镜下气压弹道碎石术(PL)治疗嵌顿性较大输尿管上段结石的的疗效。方法对30例经后腹腔镜、35例经尿道输尿管镜下气压弹道碎石术治疗的输尿管上段嵌顿性较大结石(直径>1.0cm)的临床资料进行分析。结果 RLUL组30例患者均手术成功,结石均完全取净,无严重并发症出现。PL组35例患者有8例手术失败,转为开放手术或留置双J管后行体外冲击波碎石;接受PL术组27例患者中17例术后有≥4mm残石。结论腹腔镜治疗嵌顿性较大输尿管上段结石结石清除率高,并发症少,安全有效,可作为嵌顿性较大输尿管上段结石的一线治疗方法。

Objective To compare the effectiveness of retroperitoneal laparoscopic ureterolithotomy（RLUL） and pneumatic lithotripsy（PL） on larger impacted upper-ureteral calculi.Methods Analyzed the clinical data of 30 cases of larger impacted upper-ureteral calculi（diameter greater than l.0 cm） treated by RLUL and 35 cases treated by PL.Results 30 cases in group treated by RLUL are successful.Calculi of these cases are all cleared,without any serious complication.8 cases of all 35 cases in the other group converted to the open surgery or the extracorporeal shock-wave lithotripsy after Double-J stent was indwelled.17 cases of the left 27cases treated by PL had small calculi（diameter≥4mm） in the kidney.Conclusion Laparoscope on laxrger impacted upper-ureteral calculi has merits of high calculi clearance rate,few complication,high safety and efficiency,thus it can be adopted as the preferred treatment to the larger impacted upper-ureteral calculi.