不同手术方式治疗复杂性输尿管上段结石的疗效比较

Comparative Analysis of Four Different Operation Methods for Treatment of Complex Upper Ureteral Calculi

目的比较输尿管镜碎石术(URL)、微创经皮肾镜取石术(MPCNL)、后腹腔镜下输尿管上段切开取石术(RLU)、开放输尿管切开取石(UL)治疗复杂性输尿管上段结石的疗效.方法回顾性分析2005年1月至2013年1月收治的281例复杂性输尿管上段结石患者,其中48例采用URL,113例采用MPCNL,67例采用RLU,53例采用UL.结果一次治疗成功率:URL 62.5%(30/48),MPCNL 92.9%(105/113),RLU 100%(67/67),UL 100%(53/53),P<0.05.术中出血量:URL(9.2±1.4)mL,MPCNL(72.5±5.8)mL,RLU(43.1±8.5)mL,UL(100.5±9.2)mL,P<0.05.手术时间:URL组(30.0±8.6)min短于其他3组,差异有统计学意义(P<0.05).平均住院日:URL组(4.2±1.2)d,明显短于其他3组,差异有统计学意义(P<0.05);4组的术后并发症有差异但差异无统计学意义(P>0.05).结论在复杂性输尿管上段结石治疗中,应综合考虑患者的临床情况与个人要求制定个性化的治疗方案.

Objective To compare the effects of ureteroscopic lithotripsy （URL）, minimally invasive percutaneous nephrolithotomy （ MPCNL） , retroperitoneal laparoscopic ureterolithotomy （ RLU） and open ureterolithotomy （UL） for the treatment of complex upper ureteral calculi. Methods The data of 281 patients with complex upper ureteral calculi from January 2005 to January 2013 were retrospectively reviewed. 48 patients of them received treatment of URL, 113 patients received MPCNL, 67 patients received RLU and other 53 patients received UL. Results Success rates of treatment at the first time were：URL 62.5% （30/48）, MPCNL 92.9%（105/113）,RLU 100%（67/67） and UL 100%（53/53） . The mean blood losses during the operation were：URL （9.2 ± 1.4） mL,MPCNL （72.5 ± 5.8） mL,RLU （43.1 ± 8.5） mL and UL （100.5 ± 9.2） mL. The average operation time of URL group was shorter than three other groups, and the difference was statistically significant （P〈 0.05） . The average hospital stay of URL group was also shorter than three other groups （ P〈 0.05） . The difference was not statistically significant in complications among four groups after operation （ P〈0.05） . Conclusion Clinical characteristics of patients and individual require ment should be considered comprehensively before an individual treatment choice is made for the treatment of complex upper ureteral calculi.