后腹腔镜和输尿管镜治疗输尿管上段>2cm嵌顿性结石的比较

Retroperitoneoscopic ureterolithotomy and ureteroscopi holmium:YAG laser lithotripsy for treating impacted proximal ureteral calculi that greater than 2.0 cm

目的比较后腹腔镜和输尿管镜治疗输尿管上段〉2 cm嵌顿性结石的临床效果。方法回顾分析4年来采用后腹腔镜输尿管切开取石术（RPUL）和输尿管镜钬激光碎石术（URL）治疗输尿管上段嵌顿性结石165例,男76例,女89例,年龄40-63岁,左侧81例,右侧84例,结石长径2.0-3.5cm。其中RPUL 92例,左侧38例,右侧54例。URL 73例,左侧43例,右侧30例。比较两组结石长径、肾盂分离、手术时间、术后住院时间、手术成功率、结石清除率及手术并发症等指标。结果后腹腔镜组92例,87例成功,5例术中结石滑入肾盂,均中转开放,伴并发症9例,均为术后输尿管吻合口漏尿。输尿管镜组73例,69例成功施行,4例失败而中转开放。伴并发症5例,其中输尿管小穿孔2例,术后石街2例,感染性休克1例。输尿管镜组、后腹腔镜组手术时间分别为（61±17）min、（84±24）min,术后住院时间分别为（5±1）d、（7±1）d,手术成功率分别为94.5%（69/73）、94.6%（87/92）,结石清除率分别为89.9%（62/69）、100%（87/87）,并发症发生率分别为7.3%（5/69）、10.3%（9/87）。术后住院时间两组间差异有统计学意义（P〈0.05）,结石清除率两组间差异有统计学意义（P〈0.05）,并发症发生率两组间差异无统计学意义（P〉0.05）。结论后腹腔镜输尿管切开取石术因其结石完整取出,无严重并发症,是治疗输尿管上段较大嵌顿性结石的可靠术式。

Objective To compare the effects of retroperitoneoscopic ureterolithotomy （RPUL） and ureteroscopic holmium： YAG laser lithotripsy （URL） for impacted proximal ureteral calculi.Methods 165 cases of large proximal ureteral calculi, （76 male and 89 females）, 40-63 years old, average 48 years old, 81 cases in left side and 84 cases in right side, the diameter of calculi were 2.0-3.5 cm. 92 cases underwent RPUL： （38 cases in left side and 54 cases in right side, 73 cases underwent URL： （43 cases in left side and 30 cases in right side）. Data of calculi diameter, separation of the renal pelvis, the operation time, the hospital stay after operation, the operation success-rate, stone-free rate and incidence of complication were compared between the 2 groups. Results In RPUL group, 87 cases were performed successfully, 5 cases were converted to open operation because ureteral calculi removed to the renal pelvis. 9 cases were found urine leakage after surgery. In URL group, 69 cases were performed successfully, 4 cases were converted to open operation. 5 cases got complication： 2 cases were found ureteral perforation, 2 cases were found stone street, 1 case was found septic shock. The operation time was （61±17） min vs （84±24） man, the hospital stay after operation was （4.5±0.8） d VS （7.1±1.1） d, the operation success rate was 94.5% vs 94.6%, the stone-free rate was 89.9% vs 100%, the incidence of complication was 7.3% vs 10.3%. The hospital stay after operation and the stone-free rate significant difference between two groups （P〈0.05）. The complication rate had no significant differences between two groups （P〉0.05）. Conclution RPUL is reliable in treatment of patients with impacted proximal ureteral calculi, for it can remove stones completely, without serious complication.