URL、MPCNL、RLU三种微创术式用于输尿管上段结石治疗的成功率及创伤程度比较

Success rate and trauma degree of three minimally invasive operating methods URL,MPCNL and RLU for upper ureteral calculi

目的:分析经尿道输尿管镜碎石取石术(URL)、微通道经皮肾穿刺碎石取石术(MPCNL)、后腹腔镜输尿管切开取石术(RLU)3种微创术式用于输尿管上段结石治疗的成功率及创伤程度。方法:138例输尿管上段结石患者根据手术方式不同,分为URL组48例、MPCNL组50例、RLU组40例。对比三组研究对象的治疗后一次取石成功率、术后创伤程度等差异。结果:MPCNL组、RLU组患者的一次结石取净率均显著高于URL组患者(P<0.05)。RLU组、URL组患者的血清炎症因子TNF-α、PCT、IL-1β、IL-8含量低于MPCNL组患者;血清免疫球蛋白及补体IgG、IgM、IgA、C3、C4含量均显著高于MPCNL组患者;血清内分泌激素NE、ACTH、Cor含量低于MPCNL组患者;血清疼痛介质β-EP、NGF、CGRP、5-HT、SP、PGE2含量低于MPCNL组患者,差异均具有统计学意义(P<0.05)。结论:RLU兼具高效取石及小创伤双重优势,是临床治疗输尿管上段结石最为理想的手术方式。

Objective：To analyze the success rate and trauma extent of three minimally invasive operating methods URL,MPCNL and RLU for upper ureteral calculi.Methods：According to different operating methods,138 patients with upper ureteral calculi were divided into transurethral ureteroscopic lithotripsy（URL）group（n=48）,minimally invasive percutaneous nephrolithotomy（MPCNL）group（n=50）and retroperitoneal laparoscopic ureterolithotomy（RLU）group（n=40）.Differences in one-time calculus removal success rate,postoperative trauma degree and so on were compared among the three groups after treatment.Results：One-time stone-free rate of MPCNL group and RLU group were significantly higher than that of URL group.Inflammatory factors TNF-α,PCT,IL-1βand IL-8content in serum of RLU group and URL group were lower than those of MPCNL group;immunoglobulin and complement IgG,IgM,IgA,C3 and C4content in serum were significantlyhigher than those of MPCNL group;endocrine hormones NE,ACTH and Cor content in serum were lower than those of MPCNL group;pain mediatorsβ-EP,NGF,CGRP,5-HT,SP and PGE2 content in serum were lower than those of MPCNL group.Conclusion：RLU has the advantages of both high efficiency in calculus removal and small trauma,and it is the ideal operating method for clinical treatment of upper ureteral calculi.