三种手术治疗嵌顿性输尿管上段结石的疗效比较

Efficacy of three surgical methods for treating incarcerated calculi of upper ureter

目的比较经皮肾镜取石术(PCNL)、开放性输尿管切开取石术(UL)及输尿管镜碎石术(URL)治疗嵌顿性输尿管上段结石的疗效。方法 120例嵌顿性输尿管上段结石患者,依据手术方式的不同,将患者分为PCNL组(34例)和UL组(41例)以及URL组(45例)。对三组临床效果及术后并发症、术后6个月复发情况等进行比较。结果三组术后住院时间比较,差异有统计学意义(P<0.05);三组间两两比较,差异均有统计学意义(P<0.05)。三组手术时间、术后双J管留置时间比较,差异无统计学意义(P>0.05)。术中出血量因数据不全,无法比较。三组手术一次成功率、结石清除率比较,差异均有统计学意义(P<0.05)。三组并发症比较,差异均无统计学意义(P>0.05)。结论三种治疗方法各有其优缺点。PCNL与UL最大优点是可一次性完整取净结石,PCNL具有手术创伤小、术后恢复快的优点,可根据具体病情综合考虑以制定适合的个性化治疗方案。

ObjectiveTo compare the efficacy among percutaneous nephrolithotomy （PCNL）, open ureterolithotomy （UL） and ureteroscopic lithotripsy （URL） for treating incarcerated calculi of upper ureter. MethodsA total of 120 patients with incarcerated calculi of upper ureter were divided into PCNL group（n=34）, UL group（n=41）and URL group（n=45）according to the surgical approach. The clinical efficacy, postoperative complications and recrudescence at postoperative 6 months were compared among the three groups. ResultsThere was significant difference in the postoperative hospital stay among the three groups（P〈0.05）, and statistical difference was also found in multiple comparison（all P〈0.05）.There were no significant differences in the operative duration and duration for indwelling double J tube among the three groups（all P〉0.05）. The comparison of intraoperative blood loss was not conducted due to the deficiency of data. There were significant differences in surgical one-time success rate and clearance rate of calculi among the three groups （all P〈0.05）. There was no significant difference in postoperative complications among the three groups （P〉0.05）. ConclusionEach approach has its own merits. Complete removal of stones for one time is the greatest advantage of PCNL and UL. And PCNL also has the advantages of less trauma and faster recovery.Suitable and individualized therapeutic plan should be made after synthetical consideration according to specific condition.