三种腔镜手术治疗嵌顿性输尿管上段结石的疗效比较

Comparison of three kinds of endoscopic surgery for upper ureteral calculi

目的：比较三种腔镜手术方法治疗嵌顿性输尿管上段结石的疗效。方法对218例单侧嵌顿性输尿管上段结石分别应用微创经皮肾镜取石（MPCNL）、经尿道输尿管镜取石术（URL）、后腹腔镜输尿管切开取石术（RLU）治疗，对比三种手术方式的安全性、有效性及手术并发症。结果 MPCNL 组、URL 组、RLU组一次碎石成功率依次分别为100．00％、85．19％、100．00％，平均手术时间分别为（76．35±16．20）min、（46．26±15．30）min、（89．20±19．60）min，血红蛋白下降数值分别为（22．24±8．63）g／L、（4．15±1．89）g／L、（10．68±4．55）g／L，术后1个月结石清除率分别为96．32％、79．59％、100．00％，住院天数分别为（8．56±2．13）d、（6．58±1．76）d、（9．79±2．14）d，差异均有统计学意义（t／χ^2＝36．916、27．629，均 P ＜0．05）。结论MPCNL、RLU 治疗嵌顿性输尿管上段结石均安全、有效、并发症少，但推荐首选 MPCNL，部分病例可尝试URL。

Objective To compare the efficacy of three endoscopic surgery in impacted upper ureteral calculi treatment.Methods 218 patients with impacted upper ureteral calculi were treated with minimally invasive percutaneous nephrolithotomy （MPCNL）,transurethral ureteroscope lithotripsy（URL）and retroperitoneal laparoscopic urerolithotomy （RLU）respectively.The operation safety,efficacy and complication were compared in the three groups.Results In the MPCNL group,URL group,RLU group one success rate of lithotripsy were 100.00%,85.19%,100.00% respec-tively.The mean operative time were （76.35 ±16.20）min,（46.26 ±15.30）min,（89.20 ±19.60）min respectively. Decreased hemoglobin values were （22.24 ±8.63）g/L,（4.15 ±1.89）g/L,（10.68 ±4.55）g/L respectively.The stone -free rates of one month postoperation were 96.32%,79.59%,100.00%.Length of hospital stay were （8.56 ± 2.13）d,（6.58 ±1.76）d,（9.79 ±2.14）d,respectively,the differences were statistically significant（t/χ^2 =36.916, 27.629,all P 〈0.05）.Conclusion MPCNL and URL for impacted upper ureteral calculi is safety and has good efficacy and less complications,but the MPCNL is recommended the first choice,some cases can try URL.