不同术式治疗复杂输尿管上段结石的疗效比较

目的：评估3种不同术式用于治疗复杂输尿管上段结石的疗效。方法：将我院收治的183例复杂输尿管上段结石患者,按数字随机表随机分为3组,分别行经尿道输尿管镜下碎石术（URL）、经皮肾输尿管镜取石（MPCNL）和后腹腔镜下输尿管切开取石术（RPLU）进行治疗。观察并比较治疗后3组的疗效指标。结果：URL组手术时间为（25.28±9.27）min,住院时间为（3.61±1.74）d,与其他2组相比,手术时间与住院时间明显缩短（P〈0.05）。同时,术中出血量为（58.32±11.37）mL,明显少于其他2组出血量,差异有统计学意义（P〈0.05）。URL组经治疗后的一次碎石成功率为78.69%,术后1个月结石清除率为83.61%,大大低于MPCNL组与RPLU组,组间差异显著（P〈0.05）。MPCNL组与RPLU组在结石清除率方面无显著性差异（P〉0.05）。同时,3组间术后并发症发生率差异不显著（P〉0.05）。结论：URL、RLU及MPCNL处理复杂性输尿管上端结石各有利弊,URL创伤小,术中出血量少,恢复快,对患者的侵袭性小于其他2种术式。而MPCNL及RLU则具有较高的结石清除率。在治疗过程中,应综合运用各种方法,制定治疗方案,以达到最佳的治疗效果。

A Comparison of Different Surgical Procedures for Complicated Upper Ureteral Calculi

Objective： To investigate the effect of different surgical procedures for complicated upper ureteral calculi. Method： 183 cases with complicated upper ureteral calculi in our hospital were divided into 3groups according to the random number table,There were respectively treated with transurethral ureteroscopic lithotripsy（ URL）,minimally invasive percutaneous nephrolithotomy（ MPCNL） and retroperitoneal laparoscopic ureterolithotomy（ RPLU）.The efficacy of index of the 3 groups after treatment was compared. Result：The operation time and hospitalization time was shortened compared to the other two groups（ P ＆lt; 0.05）,with operation time（ 25.28 ± 9.27） min,hospitalization time（ 3.61 ± 1.74） days. At the same time,the amount of bleeding during the operation of URL group was（ 58.32 ± 11.37） mL,which was significantly less than the other 2 groups,the difference was statistically significant（ P ＆lt; 0.05）. The stone-free rate for once of the URL group was 78.69%,after 1 month of surgery,the stone-free rate was 83.61%,which was lower than that of MPCNL group and RPLU group（ P ＆lt; 0.05）. While,the MPCNL group and RPLU group had no significant difference in the stone-clear rate（ P ＆gt; 0.05）. At the same time,the incidence of postoperative complications among the 3 groups was not significant（ P ＆gt; 0.05）. Conclusion： URL,RLU and MPCNL treatment has each advantages and disadvantages for ureteral complicated calculi. URL treatment has less trauma,less bleeding and rapid recovery. While MPCNL and RLU have a higher stone- free rate. In the course of treatment,all the methods should be used in order to achieve the best therapeutic effect.