三种微创方式治疗嵌顿性输尿管上段结石的疗效

Effects of three kinds of minimally invasive methods on impacted upper ureteric calculi

目的比较经尿道输尿管镜碎石术（URL）、经皮肾穿刺取石术（MPCNL）及腹腔镜输尿管切开取石术（LU）治疗嵌顿性输尿管上段结石的疗效和安全性。方法2012年1月至2017年10月收治的229例单侧嵌顿性输尿管上段结石患者分别采用输尿管镜碎石术、经皮肾镜取石术及腹腔镜下输尿管切开取石术治疗，比较三组手术时间、出血量、术后住院天数、并发症、术后3d及1个月的结石清除率等。结果三组间出血量比较差异有统计学意义（URL组〈LU组〈MPCNL组，P〈0．05）。三组间并发症比较差异未见统计学意义（P〉0．05）。术后住院时间URL组明显优于MRCNL组及LU组（P〈0．05）。MPCNL组及Lu组在需ESwL治疗的例数、术后3d及术后1个月的结石清除率均优于URL组（P均〈0．05），但MPCNL组与LU组比较差异未见统计学意义（P〉0．05）。结论三种手术方式治疗嵌顿性输尿管上段结石均取得了较好的疗效，主要并发症的发生率大致相同，LU、MPCNL治疗嵌顿性输尿管上段结石均有很高的结石清除率，URL结石清除率稍低。

Objective To compare the efficacy and safety of transurethral ureteroscope lithotrip- sy （URL）, the minimally invasive percutaneous nephrolithotomy（MPCNL） and laparoscopic ureterolithot- omy（LU） in treating impacted upper ureteric calculi. Methods A total of 229 cases of upper ureteral calculi from Jan 2012 to Oct 2017 were treated with ureteroscopic lithotripsy, percutaneous nephrolithoto- my and laparoscopic ureterolithotomy. The operation time, bleeding volume, postoperative hospitalization time, postoperative complications, the stone clearance rates at 3 days and 1 month after operation were compared. Results There were significant differences in the amount of bleeding among the three groups （ URL group 〈 LU group 〈 MPCNL group, P 〈 0.05 ）. There was no significant difference in the compli- cations among the three groups （ P 〉 0. 05 ）. The postoperative hospitalization time of LU group was sig- nificantly better than that of MPCNL group and URL group （P 〈 0. 05 ）. In MPCNL group and LU group, the number of cases requiring ESWL treatment, the stone clearance rates of 3 d after operation and 1 months after operation were all better than those in URL group （P 〈 0. 05 ）, but there was no significant difference between the MPCNL group and LU group（P 〉 0. 05 ）. Conclusions All of the three methods achieved good effects on impacted upper calculi, with no significant differences in the rate of postopera- tive complications. High stone-free rate can be obtained MPCNL and LU for impacted upper ureteral cal- The stone-free rate is slightly lower with URL.