后腹腔镜与经输尿管镜手术治疗输尿管上段结石的疗效比较

Comparison of therapeutic effects of transureteroscope holmium laser lithotripsy and retroperitoneal laparo-scopic ureterolithotomy for unilateral upper ureteral calculi

目的：比较输尿管镜碎石取石术与后腹腔镜输尿管切开取石术治疗单侧输尿管上段结石的疗效，探讨两种术式的适应证及临床应用价值。方法37例单侧输尿管上段结石患者，其中14例行输尿管镜碎石术（ URL组），23例行后腹腔镜输尿管切开取石术（ RLU组），两组术中均留置双J管，比较两组的手术时间、术后住院时间、结石清除率及手术并发症。结果 RLU组一次治疗成功率为100．0％，明显高于URL组的64．4％（χ2＝4．15，P＜0．05）；RLU组治疗时间、术中出血量分别为（132．0±7．8）min、（38．0±4．6）mL，明显高于URL组的（46．5±7．2）min、（10．0±3．2）mL（t＝6．23、5．20，均P＜0．05）；RLU组术后并发症发生率为8．7％，明显低于URL组的21．5％（χ2＝4．06，P＜0．05）；两组术后住院时间、结石清除率等差异均无统计学意义（均P＞0．05）。 URL组有2例中转开放手术治疗，RLU组有1例中转开放手术治疗。结论对于单侧输尿管上段结石，后腹腔镜输尿管切开取石术较输尿管镜碎石取石术一次手术结石清除率高，手术时间短，是一种安全、有效的方法。

Objective To compare the therapeutic effects of transureteroscope holmium laser lithotripsy （ URL） and retroperitoneal laparoscopic ureterolithotomy （ RLU） for unilateral upper ureteral calculi and evaluate the selection of indications and clinical value of URL and RLU .Methods 37 patients were enrolled into the study . 14 patients received URL ,23 patients received RUL .Double-J stent was routinely indwelled in both groups .The oper-ation time,hospitalization time,clearance rate of the stone and incidence of postoperative complications .Results The stone clearance rate after postoperation of RLU group was 100%, which was significantly higher than that of URL group 64.4%（χ2 =4.15,P〈0.05）.The mean operation time in RLU group was（132.0 ±7.8）min,which was sig-nificantly longer than URL group（46.5 ±7.2）min（t=6.23,P〈0.05）.The mean intraoperative blood loss of RLU group was（38.0 ±4.6）mL,which was significantly higher than URL group （10.0 ±3.2）mL（t=5.20,P〈0.05）. The postoperative complication rate of RLU group was 8.7%,which was significantly lower than URL group 21.5%（χ2 =4.06,P〈0.05）.There was no significant difference in hospitalization time and stone clearance rate between the two groups（P〉0.05）.Two cases converted to operation in URL group ,while only 1 case converted to operation in RLU group.Conclusion Laparoscopic ureterolithotomy has a higher stone clearance rate and shorter operation time compared with ureteroscopic lithotripsy .Laparoscopic ureterolithotomy is a safe and effective therapeutic method for unilateral upper ureteral stones .