相同学习曲线下两种方式治疗输尿管上段结石的疗效对比

Comparison of curative efficacy of two kinds of treatments for upper ureteral calculi under the same learning curve

目的 比较同一名医师在相同学习曲线下利用经皮肾镜取石术（percutaneous nephroscope lithotripsy,PCNL）和后腹腔镜输尿管切开取石术（retroperitoneal laparoscopic ureterolithotomy,RLUL）治疗输尿管上段嵌顿性结石的疗效.方法 选择2008年8月至2015年8月在本院接受手术的单侧嵌顿性输尿管上段结石患者92例进行研究,采用数字法随机分成PCNL组和RLUL组（各46例）.对比两组手术时间、术中出血量、术后高热（＞38.5℃）率、术后出血、输尿管内结石残留率、住院时间.结果 92例手术全部成功.术中出血量比较PCNL组（58.02±27.16） mL较RLUL组（21.74±10.18） mL出血量多（P＜0.05）.住院时间PCNL组（9.07±0.77）d较RLUL组（7.59±0.88）d长（P＜0.05）.输尿管结石残石率,PCNL组（4例8.7％）与RLUL组（0例）比较差异亦有统计学意义（P＜0.05）.术后随访1～36个月,平均10个月,两组均未发现有输尿管狭窄和结石复发.结论 PCNL和RLUL治疗输尿管上段嵌顿性结石均是安全、有效的,两者均可以选用,根据结石位置,肾积水程度,选择相应手术方式.

Objectives To compare the efficacy of percutaneous nephroscope lithotripsy （PCNL） and retroperitoneal laparoscopic ureterolithotomy （RLUL） in the treatment for ureter-stuck stones by the same doctor under the same learning curve.Methods 92 patients with obstructive upper ureteral calculus from August 2008 to August 2014 in our hospital were selected,according to the digital method who were randomly divided into PCNL group and RLUL group,each of 46 cases.The peration time,peroperative bleeding,postoperative fever rate （〉 38.5℃）,postoperative bleeding,rate of residual stones in the ureter,hospitalization time were compared.Results All the operations were completed.Peroperative bleeding of PCNL group and RLUL group was（58.02 ± 27.16）mL,（21.74 ±10.18） mL,respectively.Hospitalization time of PC NL group and RLUL group was （9.07 ± 0.77）d,（7.59 ± 0.88） d,respectively.There were statistically significant differences in rate of residual stones between the PCNL group and RLULgroup （P 〈 0.05）.The patients were followed up for 1 to 36 months （mean,10 months）,no recurrence was found in both groups.Conclusions Both PCNL and RLUL are safe,effective,and feasible for incarcerated upper ureteral calculi.