后腹腔镜输尿管切开取石与小切口取石治疗输尿管中上段结石的比较

目的比较小切口开放性输尿管切开取石术与后腹腔镜输尿管切开取石术治疗嵌顿性输尿管中、上段结石的临床效果。方法回顾性研究2010年3月至2014年3月在本院行输尿管切开取石术治疗的72例输尿管中上段结石患者，纳入标准为直径大于1.5 cm嵌顿性中上段结石以及输尿管镜碎石或体外震波碎石失败患者。其中37例行小切口切开取石，另35例行后腹腔镜切开取石。比较两组术后视觉疼痛评分（VAS ）、镇痛剂使用时间、一次性取石率、术后引流管拔除时间、手术时间、术中出血量、术后并发症、住院时间及恢复时间。结果两组患者在术中失血量、术后引流管拔除时间、一次性取石率及并发症发生率上无明显差异（P ＞0.05），小切口组手术时间明显短于后腹腔镜组（P ＜ 0.001）；而在术后连续两天 VAS值、镇痛泵使用时间、住院时间及恢复时间上，后-腹腔镜组明显优于小切口组（P＜ 0.01）。结论对于输尿管中上段的嵌顿性结石及输尿管镜碎石或体外震波碎石失败者，小切口及后腹腔镜输尿管切开取石均是安全、可靠的方案。但后腹腔镜输尿管切开取石术较小切口取石术有术后患者耐受性好、术后恢复快的优点。

Comparison Between Retroperitoneoscopic and Open Mini-incision Ureterolithotomy for the Treatment of Upper or Middle Ureteral Calculi

Objective]To compare the clinical efficacy between retroperitoneoscopic ureterolithotomy （RPLU）and open mini-incision ureterolithotomy（MIOU）for the treatment of upper or middle ureteral calculi.[Methods]A total of 72 patients with upper or middle ureteral calculi undergoing ureterolithotomy in our hos-pital from March 2010 to March 2014 were analyzed retrospectively.Patients with impacted upper or middle stones which the diameter was more than 1.5cm or failed ureteroscopic lithotripsy（URSL）/extracorporeal shock wave lithotripsy（ESWL）were enrolled in the study.Among them,37 patients underwent MIOU and 35 patients underwent RPLU.Postoperative visual analogue scales（VAS）,analgesic duration,one-time stone re-moval rate,the withdrawal time of postoperative drainage tube,operation time,intraoperative blood loss, postoperative complications,hospital stays and the recovery time were compared between two groups.[Re-sults]There was no significant difference in intraoperative blood loss,withdrawal time of postoperative drain-age tube,one-time stone removal rate and the incidence of complications between two groups（P 〉0.05）.The operation time in MIOU group was shorter than that in RPLU group（P〈 0.001）.The VAS value,analgesia pump duration,hospital stay and recovery time in RPLU group at 2 days after operation were better than con-trol group obviously（P〈 0.01）.[Conclusion]Both MIOU and RPLU for the treatment of patients with im-pacted upper or middle stones or failed URSL/ESWL are safe and reliable.Compared with MIOU,RPLU has advantages such as good tolerance and rapid postoperative recovery.