输尿管镜钬激光碎石术和后腹腔镜输尿管切开取石术治疗输尿管上段结石的临床疗效比较

Comparative Study on the Therapeutic Effect of Ureteroscopic Holmium Laser Lithotripsy and Retroperitoneal Laparoscopic Ureterolithotomy on the Upper Ureteral Stones

目的:比较输尿管镜钬激光碎石术(USL)和后腹腔镜输尿管切开取石术(RLU)治疗输尿管上段结石的疗效,探讨治疗输尿管上段结石的最佳方法。方法:回顾性分析115例输尿管上段结石患者临床资料,其中71例采用输尿管镜术治疗,44例采用后腹腔镜术治疗,比较两种手术方法的临床治疗效果。结果:后腹腔镜组的手术成功率(97.7%)明显高于输尿管镜组(83.1%)(P<0.05)。输尿管镜组和后腹腔镜组手术时间分别为(43.2±14.7)min和(79.6±24.1)min,术中出血量分别为(3.1±0.8)ml和(36.4±3.7)ml,术后住院天数分别为(3.3±2.1)d和(6.7±1.3)d,差异均具有显著统计学意义(P<0.01),输尿管镜组均优于后腹腔镜组。输尿管镜组手术后并发症6例,后腹腔镜组5例,两组并发症的发生率比较差异无统计学意义(P>0.05)。术后1个月复查腹部X线平片(KUB),输尿管镜组17例有结石残留,后腹腔镜组均无结石残留,输尿管镜组的结石残留率明显高于腹腔镜组(P<0.01)。结论:输尿管上段结石采用输尿管镜钬激光碎石术和后腹腔镜输尿管切开取石术治疗各有其优缺点。RLU具有安全、高效、创伤小、并发症少、结石清除率高的优点;而USL相对具有出血少、手术时间及住院时间短等优点,但手术成功率和结石清石率低,需其他辅助方式治疗结石。因此,泌尿外科医师应根据结石大小、位置、有无炎性息肉包裹、梗阻程度、肾积水量等术前检查结果及所拥有的设备与技术熟练程度选择最合适的治疗方法。

Objective： To compare the therapeutic effects of ureteroscopic Holmium laser lithotripsy and retroperitoneal laparoscopic ureterolithotomy,and explore the best method for upper ureteral calculi.Methods： The data of 115 patients with upper ureteral calculi were retrospectively reviewed,in which 71 cases were treated with ureteroscopic Holmium laser lithotripsy（USL） and 44 cases were treated with retroperitoneal laparoscopic ureterolithotomy（RLU）.The clinical effects of the two surgical methods was compared.Results： The operative time were（43.2±14.7） min and（79.6±24.1） min in the USL and RLU group,respectively（P0.01）.The blood loss during operation was（3.1±0.8） ml vs.（36.4±3.7） ml（P0.01）,and postoperative hospitalization time（3.3±2.1） days vs.（6.7±1.3）days,respectively（P0.01）.There were 6 and 5 cases of complications in USL and RLU group,respectively（P0.05）.The stone free rate at one month after operation of USL group were significantly higher than that of RLU group（P0.01）.Conclusion： RLU and USL had their own advantages or disadvantages for upper ureteral calculi.RLU was a safe,efficient management with minimal injuries,high stone free rate and less complications.USL was superior to a faster recovery,shorter operative time and hospital stay,lower blood loss,etc,but the success rate of primary lithotripsy and the stone free rate is lower,requiring other aids.So urologist should choose the best treatment options,based on the surgeon experiences and techniques and the reoperative test results such as the stone location,size,accompanied with/or no inflammatory polyp,degree of obstruction,hydronephrosis volume.