经皮肾镜与后腹腔镜治疗输尿管上段嵌顿结石的疗效比较

Comparison between minimally invasive percutaneous nephrolithotomy and retroperitoneal laparoscopic ureterolithotomy for impacted upper ureteral calculi

目的:比较微创经皮肾镜取石术(minimally invasive percutaneous nephrolithotomy,MPCNL)与后腹腔镜输尿管切开取石术(retroperitoneal laparoscopic ureterolithotomy,RLUL)治疗嵌顿性输尿管上段结石的有效性及安全性。方法:分析2006年6月～2012年4月我院收治的嵌顿性输尿管上段结石患者208例,年龄21～76岁,平均45.3岁。根据治疗方法分为两组,MPCNL治疗(MPCNL组)158例,RLUL治疗(RLUL组)50例,比较2组手术时间、术中出血量、术后住院时间、住院费用、结石清除率及手术并发症。结果:所有患者均耐受手术,无严重并发症发生。RLUL组手术时间为(88.6±21.9)min,显著长于MPCNL组的(64.2±18.6)min(t=-7.683,P=0.000)。术后1个月的结石清除率MPCNL组为98.7%(156/158),RLUL组为100.0%(49/49),差异无统计学意义(χ2=0.002,P=0.965)。术后并发症发生率两组差异无统计学意义(χ2=3.051,P=0.081)。术中出血量MPCNL组为(62.4±10.6)ml,显著高于RLUL组的(38.7±9.3)ml(t=14.058,P=0.000)。术后住院时间MPCNL组为(6.3±1.4)d,长于RLUL组(4.1±1.2)d(t=9.923,P=0.000)。住院费用MPCNL组为(11 562.4±1 228.5)元,高于RLUL组(9 546.6±1 082.6)元(t=10.308,P=0.000)。术后随访6～24个月,平均12个月,未见输尿管狭窄和输尿管结石复发。结论:MPCNL与RLUL在治疗嵌顿性输尿管上段结石上都具有满意的疗效与安全性,RLUL术中出血较少,但手术时间长,在有条件且技术成熟的医院可适当开展。

Objective：To compare the efficacy and safety of minimally invasive percutaneous nephrolithotomy （MPCNL） and retroperitoneal laparoscopic ureterolithotomy （RLUL） for impacted upper ureteral calculi. Method： We analyzed 208 cases of impacted upper ureteral calculus treated in our hospital between June 2006 and April 2012. The patients, aged from 21 to 76（mean, 45. 3） years, were classified into 2 groups, 158 cases received MPCNL（MPCNL Group）, and 50 cases underwent RLUL（RLUL Group）. The operation time, blood loss during operation, clearance rate of the stone, incidence of postoperative complications, hospitalization time and expense were statistically analyzed. Result： All of patients tolerated operations without severe complications. The mean op- eration time in RLUL group was（88.6 ± 21.9） min, which was significantly longer than that of MPCNL group （64.2±18.6） min, （ t =-7. 683, P =0. 000）. The stone clearance rate after one month postoperation of MPC- NL group and RLUL group was 98.7 % （156/158） and 100.0% （49/49）, but there was no signification difference between two groups（X^2= 0. 002, P = 0. 965）. There was also no signification difference in the incidence of postop- erative complications between two groups （X^2=3.051, P =0.081 ）. The mean intraoperative blood loss of MPCNL was （62.4±10.6） ml, which was higher than that of RLUL group （38.7±9.3） ml （ t =14. 058, P =0. 000）. The mean postoperative hospitalization time in MPCNL group was （6.3 ± 1.4） d, which was longer than that in RLUL group （4.1±1.2） d （ t =9. 923, P =0. 000）. The hospitalization expense in MPCNL group was （11 562. 4±1 228.5 ） yuan, which was higher than that in RLUL group （9 546.6±1 082.6） yuan （ t =10. 308, P =0. 000）. The patients were followed up for 6 to 24 months （mean, 12 months）, none of them developed ureteral stricture or recurrent stones during the period. Conclusion：Both MPCNL and RLUL are effective and safe for im- pacted upper ureteral calculi. RLUL, which results in less blood loss but longer operation time, is feasible in ad-vanced hospitals.