腹腔镜输尿管切开取石术和输尿管镜钬激光碎石术在治疗中上段输尿管结石的临床对比

目的通过比较输尿管镜钬激光碎石及腹腔镜下输尿管切开取石治疗输尿管结石的效果及并发症来探索治疗输尿管结石的最佳手术方案及手术技巧。方法60例单侧输尿管结石患者被随机分成两组，一组是在全麻下行腹腔镜下输尿管切开取石术（n=30），另一组是在硬膜外麻下行输尿管镜钬激光碎石术（n=30），术中两组常规放置双J管，通过对该60例患者的临床数据总结，比较两组患者的手术时间、住院时间、结石清除率及并发症。结果输尿管钬激光碎石组有1例患者术中转开放，其余59例均顺利完成手术，输尿管镜钬激光碎石和腹腔镜输尿管切开取石的手术时间分别是：（52．0±10．7）min和（68．6±8．0）min，住院时间是：（3．8±1．3）天和f4．7±0．8）天；结石清除率是：87％和100％，输尿管镜钬激光碎石组有4例患者出现结石上移至肾盂，术后通过体外震波碎石治疗，有2例患者术后出现发热，经加强抗感染后恢复，有2例患者在随访期间出现输尿管狭窄，经输尿管镜下行狭窄内切开并防止双J管后恢复，所有患者随访时间为6～24个月。结论腹腔镜输尿管切开取石术在治疗输尿管大的结石时相比输尿管镜钬激光碎石有更高的结石清除率及更少的手术并发症，我们的经验提示腹腔镜输尿管切开取石是治疗输尿管结石安全有效的手术方法。

Laparoscopic ureterolithotomy versus ureteroscopic holmium laser lithotripsy for middle and upper ureteralstones

Objective To explore the optimal surgical procedures and skills by comparing the efficacy of ureteroscopic holmium laser lithotripsy with that of laparoscopic ureterolithotomy for unilateral ureteral stones. Methods Sixty patients with unilateral ureteral stones were randomly assigned to receive laparoscopic ureterolithotomy under general anesthesia （n=30）, or ureteroscopic holmium laser lithotripsy under epidural or lumbar anesthesia （,=30）. Double-J stent was routinely placed in both groups. Surgical duration, length of hospital stay, stone clearance rate, and rate of perioperative complications were compared. Results Ureteroscopic holmium laser lithotripsy was successfully performed on 59 patients, and one patient needed to received open surgery intraoperatively. The mean surgical duration was （52.0 ＋ 10.7） min in ureteroscopic lithotripsy group and （68.6 ＋ 8.0）rain in laparoscopic ureterolithotomy （P〈0.01）; length of hospital stay was （3.8 ~ 1.3）days and （4.7 ＋ 0.8）days （P〈0.01）; and stone clearance rate was 87% and 100%, respectively, In ureteroscopic lithotripsy group, stones moved to the renal pelvis in 4 patients, and the residual stones were removed by extracorporeal shock-wave lithotripsy （ESWL）. 2 patients developed fever and recovered after anti-infective therapy. All patients were followed up for 6 to 24 months. Ureterostensis occurred in 2 patients during follow-up, and recovered after ureteroscopic urethrotomy was performed and 2 double-J catheters were placed for 3 months. Conclusions Laparoscopic ureterolithotomy has a higher stone clearance rate and fewer complications as compared with ureteroscopic holmium laser lithotripsy. Laparoscopic ureterolithotomy is a safe, effective procedure for ureteral stones.