微创经皮肾镜取石术和单孔后腹腔镜输尿管切开取石术治疗输尿管上段结石的对比研究

目的 比较微创经皮肾镜取石术和单孔后腹腔镜输尿管切开取石术治疗输尿管上段结石的效果。 方法 2013年1月—2014年10月收治的400例输尿管上段结石患者入选本研究，按照数字随机法分为2组，对照组采取微创经皮肾镜取石术治疗，观察组采取单孔后腹腔镜输尿管切开取石术治疗，比较2组患者手术一般情况及结石清除率及术后并发症发生率。 结果 观察组患者手术时间为(99.8±21.6)min，显著长于对照组的(56.9±19.6)min，P＜0.05；观察组患者术中血红蛋白下降水平为(0.4±0.1)g/L，显著低于对照组的(0.7±0.2)g/L，P＜0.05。观察组术后肉眼血尿持续时间、术后下床活动时间及住院时间分别为(0.9±0.4)d、(1.2±0.7)d、(3.6±0.9)d，均明显短于对照组(3.6±1.3)d、(4.3±1.2)d、(5.4±1.7)d，差异具有统计学意义，均P＜0.05。观察组结石清除率为100.0%(200/200)，显著高于对照组的95.5%(191/200)，P＜0.05；观察组患者术后并发症3例(1.5%)，显著低于对照组40例(20.0%)，P＜0.05。 结论 单孔后腹腔镜输尿管切开取石术治疗输尿管上段结石效果较佳，但手术时间较长，术后并发症发生率低，具有重要的临床价值。 

A comparative study of minimally invasive percutaneous nephrolithotomy and single incision retroperitoneoscopic ureterolithotomyfor upper ureteral calculi

Objective To compare the effect of minimally invasive percutaneous nephrolithotomy and single incision retroperitoneoscopic ureterolithotomy for upper ureteral calculi. Methods Total 400 cases of upper ureteral calculi in our hospital from January in 2013 to October in 2014 were enrolled and were randomly divided into two groups.The control group adopted minimally invasive percutaneous nephrolithotomy,while the observation group adopted single incision retroperitoneoscopic ureterolithotomy.The general information,stone clearance rate and incidence of postoperative complications were compared between the two groups. Results In the observation group,the operation time was(99.8±21.6) min which was significantly longer than (56.9±19.6) min in the control group(P<0.05).The decreased levels of hemoglobin in theobservation group was (0.4±0.1) g/L which was significantly lower than (0.7±0.2)g/L in the control group(P<0.05).The duration of postoperative naked eye hematuria,postoperative ambulation and hospitalization in the observation group were (0.9±0.4) d,(1.2±0.7) d and (3.6 ±0.9) d,respectively,which were significantly shorter than (3.6±1.3) d,(4.3±1.2) d and (5.4±1.7) d in the control group,the difference was statistical significant(P<0.05).The stone clearance rate in the observation group was 100.0%,which was significantly higher than 95.5% in the control group(P<0.05).The postoperative complications was found in 3 cases(1.5%) in the observation group,which was significantly lower than 20.0% in the control group(P<0.05). Conclusion The single incision retroperitoneoscopic ureterolithotomy for upper ureteral calculi can achieve a better effect as compared with minimally invasive percutaneous nephrolithotomy,with a lower incidence of postoperative complications,but the operation time was long.The clinical application value should be focused.