无管化微创经皮肾镜与后腹腔镜手术治疗嵌顿性输尿管上段结石的疗效比较

目的:比较无管化微创经皮肾镜与后腹腔镜手术治疗嵌顿性输尿管上段结石的疗效。方法:回顾性分析2010年4月~2013年12月间收治的85例嵌顿性输尿管上段结石患者的临床资料,其中施行无管化微创经皮肾镜碎石取石术(TMPCNL)66例,后腹腔镜下输尿管切开取石术(RPUL)19例。比较分析两种手术方法的术前资料、术中出血量、手术时间、术后住院时间、术后血尿时间、手术并发症、息肉发生率及结石清除率。结果:85例患者均手术成功,无中转开放手术者。TMPCNL组平均手术时间、术中出血量、术后住院时间、术后血尿时间、息肉发生率、术后结石清除率、术后并发症发生率分别为(98.4±32.2)min、(29.1±20.0)ml、(6.1±1.4)d、(5.3±1.5)d、58%、95%、9%。RPUL组分别为(199.2±78.9)min、(76.3±91.8)ml、(10.1±3.8)d、(3.3±1.4)d、53%、100%、26%。TMPCNL组在手术时间、术中出血量、术后住院时间、术后并发症发生率上优于RPUL组,差异有统计学意义(P0.05),而RPUL组在术后血尿时间优于TMPCNL组,差异有统计学意义(P0.05)。两者在息肉发生率及结石清除率上差异无统计学意义(P0.05)。结论:两种手术方法都具有创伤小、清石率高的优点。TMPCNL手术时间更短,术后疼痛及并发症更少,安全性高,可以作为嵌顿性输尿管上段结石的常规治疗方法。

Comparison between tubeless minimally invasive percutaneous nephrolithotomy and retroperitoneoscopic ureterolithotomy for impacted upper ureteral calculi

Objective：To compare the effects between tubeless minimally invasive percutaneous nephrolithoto- my （TMPCNL） and retroperitoneoscopic ureterolithotomy （RPUL） for impacted upper ureteral calculi. Method： The clinical data of 85 patients with impacted upper ureteral calculi treated in our hospital from April 2010 to De- cember 2013 were analyzed retrospectively. Sixty-six patients underwent TMPCNL, while 19 patients underwent RPUL. The preoperative data, intraoperative blood loss, operative duration, postoperative hospital stay, postop- erative hematuria duration, complication rates, polyp rates and stone-free rates were compared between two groups retrospectively. Result： All procedures were performed successfully without conversion to open surgery. The clinical data of group of TMPCNL were as follows： the mean operative duration was （98.4±32.2） minutes; the mean intraoperative blood loss was （29.1 ± 20.0） ml; the mean postoperative hospital stay was （6.1 ± 1.4） days; the mean postoperative hematuria duration was （5.3±1.5） days; the polyp rate was 58%; the stone-free rate was 95 % ; the complication rate was 9 %. The clinical data of group of RPUL were as follows： the mean oper- ative duration was （199.2±78.9） minutes; the mean intraoperative blood loss was （76.3±91.8） ml; the mean postoperative hospital stay was （10.1 ± 3.8） days; the mean postoperative hematuria duration was （3.3 ± 1.4） days; the polyp rate was 53%; the stone-free rate was 100%; the complication rate was 26%. In 6iaerative dura- tion, intraoperative blood loss, postoperative hospital stay and complication rates, group TMPCNL were better than group RPUL. The differences were statistically significant （P〈0.05）. In postoperative hematuria duration, group RPUL was superior to group TMPCNL. The difference was statistically significant （P〈0.05）. In polyp rates and stone-free rates, the differences showed no statistical significance （P〉0.05）. Conclusion： Both TMPCNLand RPUL have advantages of minimal invasion and high stone-free rate. TMPCNL can be considered as the rou- tine procedure in treatment of impacted upper ureteral calculi because of shorter operation time, less postoperative pain, fewer complications and high safety.