复杂性输尿管上段结石不同术式的疗效对比

Comparison of therapeutic effect among three minimally invasive surgical treatments for complicated upper ureteral calculi

目的:对比3种微创术式治疗复杂性输尿管上段结石的临床疗效。方法:回顾分析2006年8月至2012年10月324例复杂性输尿管上段结石患者的临床资料,其中192例行经尿道输尿管镜下钬激光碎石术(transurethral ureteroscopic litho-tripsy,URL),38例行微创经皮肾输尿管镜下钬激光碎石术(minimally invasive percutaneous nephrolithotomy,MPCNL),94例行腹膜后腹腔镜输尿管切开取石术(retroperitoneal laparoscopic ureterolithotomy,RLU)。结果:MPCNL组并发症发生率明显高于其他两组;住院时间URL组明显少于其他两组;术后1个月拔除双J管后复查B超及静脉尿路造影,结石清除率URL组明显低于其他两组。结论:URL、RLU及MPCNL处理复杂性输尿管上端结石各有利弊,MPCNL及RLU具有较高的结石清除率,并发症发生率及住院时间URL明显少于其他两种术式。

Objective：To compare the efficacy of three minimally invasive surgical treatments for complicated upper ureteral calculi. Methods：The clinical data of the 324 patients who had complicated upper ureteral calculi from Aug. 2006 to Oct. 2012 were retrospectively analyzed, 192 of them received transurethral ureteroscopic lithotripsy （URL） ,38 underwent minimally invasive percuta- neous nephrolithotomy （ MPCNL）, and 94 retroperitoneal laparoscopic ureterolithotomy （RLU）. The treatment resuhs of the three kinds of surgical operations were comparatively analyzed. Results ： The complication rate of MPCNL was significantly higher than that of the other two groups. The length of hospital stay in the URL group was significantly shorter than that in the other two groups. The double-J tube was removed one month later, stone-free rate of URL was significantly lower than the other two groups, which was proved by B ul- trasound and intravenous urography. Conclusions：URL, RLU and MPCNL have their virtues and faults in managing complicated upper ureteral calculi. MPCNL and RLU have higher stone-free rate, while URL has advantages in complication rate and length of hospital stay.