输尿管上段嵌顿性结石的三种微创手术疗效分析

目的比较经尿道输尿管镜碎石取石术（URL）、微创经皮肾镜碎石取石术（MPCNL）和后腹腔镜输尿管切开取石（RLU）三种微创手术处理输尿管上段嵌顿性结石疗效。 方法回顾性分析2013年12月至2017年12月在我院治疗的输尿管上段嵌顿性结石69例，其中URL组23例，MPCNL组26例，RLU组20例。 结果三组患者年龄、结石位置、结石大小、肾积水比较差异无统计学意义（P>0.05）。三组手术时间、术后住院日分别为URL组（34±11）min、（3.2±2.5）d，MPCNL组（59±12）min、（5.5±2.2）d，RLU组（122±25）min、（8.3±2.1）d，差异均有统计学意义（P<0.05）；三组手术成功率、1个月净石率分别为，URL组82.6%（19/23）、78.3%（18/23），MPCNL组100%（26/26）、100%（26/26），RLU组95%（19/20）、100%（20/20），URL与其余两组对比差异均有统计学意义（P<0.05）。 结论MPCNL具有手术时间短、成功率高、净石率高特点，治疗输尿管上段嵌顿性结石效果确切，若合并肾结石可作为首选治疗；URL不推荐作为输尿管上段结石首先治疗；RLU可作为输尿管上段嵌顿结石可选择性治疗。

Effect of three kinds of minimally invasive surgery for treatment of impacted upper ureteric calculi

ObjectiveTo compare the effecacy of minimally invasive treatment of impacted upper ureteric calculi by transureteroscopic lithotripsy (URL), minimally invasive percutaneous nephrolithotomy (MPCNL) and retroperitoneal laparoscopic ureterolithotomy (RLU). Methods69 cases of impacted upper ureteric calculi who were treated in our hospital from December 2013 to December 2017 were retrospectively analyzed, 23 cases were treated by URL, 26 cases by MPCNL and 20 cases by RLU. ResultsThere was no significant difference in age, stone position, stone size and hydronephrosis in the three groups (P>0.05). The operative time and postoperative hospital stay of the three groups were (34±11) min and (3.2±2.5) d in URL group, (59±12) min and (5.5±2.2) d in MPCNL group, (122±25) min and (8.3±2.1) d in RLU group, the difference were statistically significant between the three groups (P<0.05). The success rate and stone clearance rate of the three groups were 82.6% (19/23) and 78.3% (18/23) in URL group, 100% (26/26) and 100% (26/26) in MPCNL group, 95% (19/20) and 100% (20/20) in RLU group, the difference among URL and the other two groups were statistically significant (P<0.05). ConclusionsMPCNL has the characteristics of short operation time, high success rate and high stone clearance rate, which is effective in the treatment of incarcerated upper ureteral calculi, MPCNL can be the first choice of treatment if combined with renal calculi. URL is not recommended as the first treatment for upper ureteral calculi. RLU can be used as a selective treatment for upper ureteral calculi.