不同微创方式治疗输尿管上段结石的疗效比较

Efficacy comparison of different minimally invasive procedures in treatment of upper ureteric calculi

目的探讨不同微创方式治疗输尿管上段结石的临床疗效。方法回顾分析2012年7月至2015年8月榆林市第二医院收治的80例输尿管上端结石且行微创取(碎)石术治疗的患者临床资料。根据微创手术方式的不同,将患者分为微创经皮肾镜取石术(MPCNL)组32例、经尿道输尿管镜碎石术(URL)组29例及腹膜后腹腔镜输尿管切开取石术(RLU)组19例,比较3组手术时间、术后住院天数、结石清除率及并发症等指标。结果 RLU组结石长径长于URL组和MPCNL组(P<0.05)。3组手术时间比较,RLU组>MPCNL组>URL组(P<0.05)。3组术后住院天数比较,MPCNL组>RLU组>URL组(P<0.05)。MPCNL组和RLU组术后结石清除率均高于URL组(P<0.05),但MPCNL组与RLU组术后结石清除率比较,差异无统计学意义(P>0.05)。3组并发症发生率及术后需行ESWL治疗的比率比较,差异均无统计学意义(P>0.05)。结论 MPCNL、URL和RLU均为治疗输尿管上段结石的有效方法。对结石体积较大或URL失败患者,可选择MPCNL;对于URL或MPCNL手术失败者,可考虑采用RLU。

Objective To explore the clinical efficacy of different minimally invasive procedures in the treatment of upper ureteral ()alculi.Methods The clinical data of 80 patients with upper ureteral calculi,ever treated with minimally invasive lithotomy in our hospital ()rom Jul 2012 to Aug 2015,were retrospectively analyzed.According to different minimally invasive procedures,all patients were divided into ()he MPCNL group (n =32),the URL group (n =29) and the RLU group (n =19),and such indicators as operation time,postoperative ()ospitalization time,calculi clearance rate and postoperative complications among the three groups were compared.Results The calculi ()ength and diameter in the RLU group were significantly longer than those in the URL group and MPCNL group (P ＜ 0.05).The operation ()ime of RLU group was the longest and that of URL group was the shortest (P ＜0.05),but the postoperative hospital stay of MPCNL group ()as the longest and that of URL group was the shortest (P ＜ 0.05).The calculi clearance rates in the MPCNL group and RLU group were significantly higher than that in the URL group (P ＜ 0.05),but the difference between the MPCNL group and the RLU group was not statistical()y significant (P ＞ 0.05).There were no significant difference in the incidences of postoperative complications and necessity for ESWL treatment among the three groups (P ＞ 0.05).Conclusion All procedures of MPCNL,URL and RLU are effective methods for the treatment of ()pper ureteral calculi.Thereinto,MPCNL are suitable for patients with larger calculi or failed URL,and when URL or MPCNL fail,RLU can ()e considered to use.