多种微创手术治疗第4腰椎水平输尿管结石的对比研究

Comparative study of a variety of minimally invasive surgeries for ureteral calculi of the fourth lumbar vertebrae

目的探讨提高第4腰椎水平输尿管结石治疗效果的方法。方法回顾性分析2009年7月至2016年3月我科收治的358例第4腰椎水平的输尿管结石患者的临床资料,行微创经皮肾镜碎石取石术(MPCNL)187例、经尿道输尿管镜手术(URL)86例、经皮肾穿刺造瘘联合经尿道输尿管镜碎石术23例、经尿道输尿管软镜手术(RIRS)62例,对其治疗效果及并发症进行分析。结果 187例行MPCNL,一次清石率96.3%,86例行URL,一次清石率90.7%,残留结石均经体外冲击波碎石(ESWL)及排石治疗后全部排出,23例行经皮肾穿刺造瘘联合经尿道输尿管镜碎石术,一次清石率100%,62例行RIRS,一次清石率100%。RIRS组恢复最快,住院时间最短。无输血、输尿管穿孔等,随访1~12个月,未出现大出血、输尿管狭窄等严重并发症。结论治疗第4腰椎水平输尿管结石可采用MPCNL、URL、RIRS,部分难治性病例可考虑应用经皮肾穿刺造瘘联合经尿道输尿管镜碎石术,随着软镜技术的开展,RIRS可作为伴轻中度肾积水的第4腰椎水平输尿管结石的首选。

Obiective To explore the minimally invasive means for the treatment of ureteral calculi of the fourth lumbar vertebrae. Methods The clinical data of 358 cases were analyzed retrospectively. One hundred and eighty-seven eases were treated by minimally invasive pereutaneous nephrolithotomy （MPCNL）, 86 cases were treated by transurethral ureteroseopie pneumatic or holmium laser lithotripsy （URL）, 23 eases by combination ofpereutaneous nephrostomy and tmnsurethral ureteroscopie lithotripsy, 62 eases were treated by retrograde intra-renal surgery （RIRS）. The efficacy and complications were compared. Results The stone-free rate of one time was 96.3%, 90.7%,100% and 100%, respectively. Residual stones were removed by adjuvant therapy. Fastest recovery and shortest hospital stay was observed in RIRS group. No severe complication were noted during 1 to 28 months follow-up.Conclusion MPCNL, URL, combination of percutaneous nephrostomy and transurethral ureteroseopie lithotripsy, and RIRS are common treatments for ureteral calculi of the fourth lumbar vertebrae. Combination of pereutaneous nephrostomy and transurethral ureteroseopy can be applied for some refractory eases. With the development of RIRS, RIRS is the fwst choice of ureteral calculi of the fourth lumbar vertebrae with mild to moderate hydronephrosis.