微创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

Effect Comparison on Minimally Invasive Percutaneous Nephrolithotomy and Retroperitoneal Laparoscopic Ureterolithotomy in the Treatment on Impacted Upper Ureteral Stones

目的比较微创经皮肾镜钬激光碎石与后腹腔镜输尿管切开取石术治疗输尿管上段嵌顿结石的临床疗效。方法回顾性分析2011年3月-2012年12月我院收治的65例输尿管上段结石患者的临床资料。其中，35例行微创经皮肾镜钬激光碎石，30例行后腹腔镜输尿管上段切开取石术。比较两组手术时间、术中出血量、结石清除率及平均住院日等指标。结果微创经皮肾镜组手术时间明显短于后腹腔镜组（（62．2±20．2）minvs（73．5±22．4）rain），术中出血量明显多于后腹腔镜组（（63±12）ml vs（36±14）m1），差异均具有统计学意义（P〈0．05）；而两组结石清除率及平均住院日比较均无统计学差异（P〉0．05）。经皮肾镜组术后出现大出血1例，发热2例，结石残留（〈4mm）1例。后腹腔镜组出现发热1例，尿瘘1例。所有患者术后随访3个月，复查B超未见残留结石。结论微创经皮肾镜取石术和后腹腔镜输尿管切开取石术均可有效治疗输尿管上段嵌顿结石，应根据临床具体情况选择适合的手术方法。

Objective To compare the efficacy of mini-invasive percutaneous nephrolithotomy （MPC- NL） and retroperitoneal laparoscopic ureterolithotomy （RLUL） for the treatment of impacted upper ureteral stones. Methods A total of 65 cases with impacted upper ureteral stones admitted from March 2011 to December 2012 were analyzed retrospectively. MPCNL was performed in 35 cases （ as MPCNL group） and RLUL in 30 cases （ as RLUL group）. The operative time, intra-operative blood loss, clearance rate of calculi and hospital stays were compared between two groups. Results The operation time of MPCL group was significantly less than that of 1 aparoscopic group （62.2± 20.2 min vs. 73.5 ± 22.4 min, P 〈 0.05 ）, and blood loss of MPCL group was significantly more than that of RULU group （63 ± 12 ml vs. 36 ± 14 ml, P 〈0.05） . There was no statistic difference in clearance rate of stones and hospital stays between two groups （P 〉 0.05 ）. Postoperative hemorrhea was found in 1 case, fever in 2 cases and residual stones （with diameter 〈4 ram） in 1 case in MPCNL group, and fever in 1 case and urinary fistula in 1 case in RLUL group. All cases were followed up for 3 months without residual stones. Conclusions Both MPCNL and RULU can applied in the treatment of impacted upper ureteral calculi effectively. The suitable surgical therapies would be chosen according to the clinical situations.