后腹腔镜与输尿管镜技术用于感染性输尿管上段结石取石碎石的比较

Comparison between retroperitoneal laparoscopic ureterolithotomy and ureteroscopic lithotripsy in treating obstructive upper ureteral stones with urosepsis

目的比较腹腔镜输尿管切开取石术与输尿管镜钬激光碎石术治疗有上尿路感染病史的梗阻性输尿管上段结石的疗效和安全性。方法回顾性分析189例有上尿路感染病史的梗阻性输尿管上段结石患者的临床资料,统计两种手术方式的结石清除率、术后并发症,特别是感染并发症情况,评价两种手术方式的疗效和安全性。结果腹腔镜手术组患者81例,输尿管镜手术组患者108例。两组患者的年龄、性别比例无统计学差异。腹腔镜手术组患者的结石直径[(16.1±1.4)mmvs.(10.4±1.6)mm]、手术时间[(78.5±12.6)min vs.(37.3±14.7)min,P<0.05]、住院时间[(7.6±1.5)d vs.(4.7±1.8)d,P<0.05)]均明显大于输尿管镜手术组患者(P<0.05)。腹腔镜手术组术后1月时的结石清除率为98.8%,输尿管镜组为88.9%,差异具有统计学意义(P<0.05)。腹腔镜手术组患者术后高热(>38.5℃)的发生率明显低于输尿管镜手术组(4.9%vs.11.1%,P<0.05)。结论对于有明确上尿路感染病史的梗阻性输尿管上段结石患者,腹腔镜切开取石术较输尿管镜手术结石清除率高,术后感染并发症少,但手术时间、住院时间较长。

Objective To compare the safety and efficacy of retroperitoneal laparoscopic ureterolithotomy（RPLU）and ureteroscopic lithotripsy（URSL）in the treatment of obstructive upper ureteral stones with urosepsis.Methods The medical records of 189 patients who had obstructive upper ureteral stones presented with urosepsis undergoing RPLU or URSL at our hospital were reviewed retrospectively.The stone clearance rates and complications were compared and analyzed.Results Of all patients,81 received RPLU and108 underwent URSL.There were no statistical differences in terms of age and gender between the two groups of patients.RPLU patients had bigger stones[（16.1±1.4）vs.（10.4±1.6）mm,P0.05],longer operation time[（78.5±12.6）min vs.（37.3±14.7）min,P0.05]and hospital stays[（7.6±1.5）d vs.（4.7±1.8）d,P0.05）,and higher stone clearance rate（98.8% vs.88.9%,P0.01）than those of URSL patients.The incidence of high fever（38.5 ℃）after RPLU was significantly less than that of URSL（4.9%vs.11.1%,P0.05）.Conclusions For the surgical treatment of obstructive upper ureteral stones presented with urosepsis,RPLU can provide better stone clearance rate and cause less fever than URSL,but the operation time and hospital stay are longer than those of URSL.