三种不同微创手术方法治疗嵌顿性输尿管上段结石的疗效探讨

目的比较嵌顿性输尿管上段结石的三种不同微创手术治疗的效果。方法分别用微创经皮肾镜取石术(MPC-NL)、后腹腔镜输尿管切开取石术(RUL)、输尿管镜下碎石术(URL)治疗嵌顿性输尿管上段结石56例、16例、43例。回顾比较三种方法的疗效、并发症等。结果 MPCNL组、RUL组、URL组术后结石清除率分别是92.86%(52/56)、100%(16/16)、69.77%(30/43);平均手术时间分别是67±15min、79±17min、43±12min;术后血红蛋白下降分别是5.96%±0.61%、0.89%±0.12%、0.67%±0.07%;平均住院时间分别是9.7±1.4d、9.3±2.3d、7.5±1.7d;住院费用分别是12325±1147元、13237±1195元、8783±976元;术中并发症发生率分别是8.92%(5/56)、0、16.28%(7/43),其中URL组发生了输尿管断裂2例;术后感染发生率分别是28.57%、6.25%、20.93%。结论治疗嵌顿性输尿管上段结石MPCNL安全疗效好、清石率高、可作为首选;RUL有一定创伤,安全有效可作为其他方法失败的补救措施,将逐步取代开放性输尿管切开取石;URL清石率低、并发症相对较多。

A investigatinon for the first choice of the treatment of impacted upper ureteral calculi

Objective To investigate the best choice of the treatment of impacted upper ureteral calculi. Methods Fifty-six cases with impacted upper ureteral calculi were treated by minimally invasive percutaneous nephrolithotomy（MPCNL）, 16 cases by retroperitoneoscopic ureterolithotomy（RUL）, and 43 cases by uroteroscopic lithotripsy（URL）. The efficacy and complications of the three groups were compared retrospectively. Results The stone-free rate of MPCNL group, URL group and RUL group was 92.86% （52/56）, 100%（16/16） and 69.77%（30/43） respectively. The operation time was 67±15 min,79±17 min and 43±12 min, respectively. The mean decrease of haematoglobin was 5.96%±0.61%,0.89%±0.12% and 0.67%±0.07%, respectively. The mean hospital stay was 9.7±1.4 day,9.3±2.3 day and 7.5±1.7 day, respectively. The mean hospital cost was 12325±1147 yuan. 13237±1195 yuan and 8783±976 yuan, respectively. The rate of complications was 8.92%（5/56）,0 and 16.28%（7/43）, respectively, 2 cases of ureter rupture occurred in URL group. The rate of infection after operation was 28.57% .6.25% and 20.93%, respectively. Coneluaions MPCNL, which was characterized by its safety, the high clearance rate of ureteral calculi and much more minimal invasiveness, could be the best choice for the treatment of impacted proximal ureteral calculi. RUL, which was gradually selected instead of the open ureterolithotomy, was also safe and effective. URL was limited by its complications and not recommended for the treatment of the impacted upper ureteral calculi.