输尿管镜钬激光碎石术与传统开放手术治疗较大输尿管结石疗效比较

Open ureterolithotomy versus urethroscopic holmium YAG laser lithotripsy for huge ureteral calculi

目的 比较经尿道输尿管镜下钬激光碎石取石术与传统开放手术治疗直径较大输尿管结石的疗效及优缺点.方法 选取2009年6月至2017年6月期间本院收治的110例罹患较大输尿管结石的患者,结石直径均大于15 mm,其中62例患者行经尿道输尿管镜下钬激光碎石取石术（URL组）,48例采取开放手术取石（OU组）治疗,观察两组临床疗效、手术时间、术中出血量、住院时间、并发症及术后恢复情况.结果 经尿道输尿管镜下钬激光碎石取石术组有1例患者术中转开放手术,URL组的术后1周清石率为82.00％,术后1-2月清石率为93.50％,OU组的术后1周清石率和术后1-2月清石率均为100.00％;经尿道输尿管镜下钬激光碎石取石术与传统开放手术的手术时间分别为（42±27） min和（73±35） min,术后住院时间分别为（3.1±1.8）d和（6.8±2.2）d,差异均有统计学意义（均P＜ 0.05）.结论 经尿道输尿管镜下钬激光碎石取石术是治疗输尿管结石安全有效的手术方法,但开放手术对于某些特殊病例也是可选的.

Objective To evaluate the efficacies of urethroscopic holmium YAG laser lithotripsy（ureteroscopy） and open ureterolithotomy for ureteral calculi more than 15 mm in diameter. Methods 110 patients with ureteral calculi over 15 mm in diameter treated at our hospital from June, 2009 to June, 2017 were selected. 62 patients were treated with urethroscopic holmium YAG laser lithotripsy （URL group） and 48 patients with open ureterolithotomy （OU group）. The operative effect, operation time, bleeding volume, hospital stay, complication, and postoperative recovery were investigated in both groups. Results One patient in the URL group was transferred for open surgery. One week and 1-2 months after the operation, the calculi clearance rates were 82.00% and 93.50% in the URL group and were 100.00% and 100.00% in the OU group. The mean operation time and mean postoperative hospital stay were （42±27） mins and （3.1±1.8） days in the URL group and were （73±35） mins and （6.8±2.2） days in the OU group（P〈0.05）, respectively. Conclusions For most ureteral calculi patients, urethroscopic holmium YAG laser lithotripsy is an effective and safe treatment. For several special cases, open ureterolithotomy may be the reasonable therapeutic option.