微创经皮肾镜与后腹腔镜在治疗输尿管上段结石的临床应用

【目的】比较微创经皮肾镜取石术（MPCNL）与后腹腔镜输尿管切开取石术（RLUL）治疗输尿管上段结石的有效性及安全性。【方法】对105例单侧输尿管上段结石分别采用MPCNL（53例）或RLUL（52例）治疗，对比2组手术时间、术中出血、结石清除率、术后高热（〉38℃）率、住院时间和住院费用。【结果】RLUL组手术时间为（75．4±20．6）rain，长于MPCNI．组（58．2±17．3）min（t=4．6365，P=0．000）。术中出血量MPCNL组平均（75±16）mI．，高于RLUI，组（30±11）mI。（t=4．6365，P=0．000）。术后结石清除率MPCNL纽为96．2oA（51／sa），RLUL纽为100．0％（52／52），差异无显著性（t=0．49，P〉0．05）。术后发热两组差异无显著性（t=0．00，P〉0．05）。住院时间MPCNI。组为（7．2±1．6）d，长于RLUL组（4．3±1．3）d（t=10．1820，P=0．000）。住院费用MPCNI。组平均（11423．63±1532．75）元，高于RLUL组（8237．23±1123．58）元（t=12．1653，P〈0．05）。【结论】MPCNL与RLUL在治疗输尿管上段结石具有满意的疗效与安全性，RLUL取石效果确切，损伤小，术后并发症少，恢复快，可广泛应用于输尿管上段结石。

Clinical Application of Minimally Invasive Percutaneous Nephrolithotomy and Retroperitoneal Laparoscopic Ureterolithotomy for Upper Ureteral Calculi

Objective] To compare the effects and safety of minimally invasive percutaneous nephrolithotomy（MPCNL） and retroperitoneal laparoscopic ureterolithotomy（RLUI.） for upper ureteral calculi. Methods] A total of 105 patients with unilateral upper ureteral calculi were treated with MPCNL（ n = 53） or RLUL （ n =52）. The operation time, blood loss during operation, clearance rate of the stone, incidence of postoperative hyperpyrexia, hospitalization time and expense were statistically analyzed. Results] The mean operation time in RLUL group was （75.4±20.6）rain, which was longer than that in MPCNL group（58.2±17.3）mini （ t =4. 6365, P =0. 000）. The mean intraoperative blood loss of MPCNL was （75±16）mL, which was higher than that of RLULgroup（30＋11mL）（t =4. 6365, P=0. 000）. The stone clearance rate of MPCNLgroup and RLUL group was 96.2% and 100 % （52/52）, but there was no significant difference between two groups（ t =0.49, P 〉0. 05）. There was also no significant difference in the incidence of postoperative hyperpyrexia between two groups（ t =0.00, P 〉0.05）. The mean hospitalization time in MPCNL group was （7.2±1.6） d, which was longer than that in RLUL group（4.3±1.3）d]（ t =10. 1820, P =0. 000）. The hospitalization expense in MPCNL group was （11 423.63± 1 532.75） yuan, which was higher than that in RLUL group（8 237. 23±1 123.58） yuan（ t = 12. 1653, P〈0. 05）. Conclusion]Both MPCNL and RLUL are effective and safe for upper ureteral calculi. RLUL has certain effect with little trauma, few complications and quick reeow cry, so it can be widely applied to upper ureteral calculi.