不同微创方法治疗复杂性输尿管上段结石的比较

目的总结复杂性输尿管上段结石的有效治疗方法。方法回顾性分析经尿道输尿管镜碎石（URL）、微创经皮输尿管镜碎石（MPCNL）以及后腹腔镜输尿管切开取石术（RLU）治疗复杂性输尿管上段结石患者的临床效果，比较3种治疗方法的成功率及结石清除率。结果285例患者中，URL治疗121例，一次手术成功率70．1％，改开放手术5例，术后1个月结石清除率为79．3％。MPCNL治疗94例，一次手术成功率86．0％，改开放手术6例，术后1个月结石清除率为92．1％。RLU治疗70例，一次手术成功率97．0％，改开放手术2例，术后1个月结石的清除率为100％。结论．对于复杂性输尿管上段结石的微创治疗，应根据患者临床情况及实际要求制定治疗方案。

Comparison of different treatments for complex upper ureteral calculi

Objective To evaluate the efficacy of ureteroscopic lithotripsy （URL）, minimally invasive percutaneous nephrolithotomy （MPCNL） and retroperitoneal laparoscopic ureterotomy（RLU） for the treatment for complex upper ureteral calculi. Methods A total of 285 patients with complex upper ureteral calculi treated by URL, MPCNL or RLU from September 2004 to December 2007 were analyzed retrospectively. Results Among 285 patients, 121 patients were treated by URL. The success rate of URL on one session was 70.1% and the stone-free rate of 1 month later was 79.3%, five patients converted to ureterolithotomy. 94 patients were treated by mPCNL. The success rate of mPCNL on one session was 86.0% and the stone-free rate of 1 month later was 92.1%, six patients transferred to ureterolithotomy. 70 patients were treated by RLU. The success rate of RLU on one session was 97.0% and the stone-free rate of 1 month later was 100% , two patients transferred to ureterolithotomy. Conclusion In selected patients with complex upper ureteral stones, we should choose a therapy according to their clinical condition and actual demand.