复杂性输尿管上段结石微创术式选择与疗效比较

目的探讨复杂性输尿管上段结石微创手术方式的选择及其疗效分析。方法回顾2005年9月至2011年9月选择经尿道输尿管镜钬激光碎石取石术(URL)、微创经皮肾输尿镜碎石取石术(MPCNL)和后腹腔镜输尿管切开取石术(RLU)治疗复杂性输尿管上段结石患者85例,同一手术操作者,比较术中并发症发生情况、结石清除率、手术时间、住院时间和费用等方面临床资料。结果全部患者取结石成功,发生中转手术取石:URL组4例、MPCNL组3例;MPCNL组有3例患者需要术中输血;术后发现URL组有6例患者结石残留;而在手术时间、住院时间和费用方面,URL组手术及住院时间短、费用低,MPCNL组手术时间最长,而RLU组费用最高;三种不同术式比较,均有统计学差异。结论 URL发生并发症少、损伤小、费用低,是治疗复杂性输尿管上段结石的首选。

Minimally invasive surgical options and effects of complex upper ureteral stones

Objective To explore the surgical options and analyze the efficacy of minimally invasive surgical approaches to complex stones in upper ureter.Methods To review the data of 85 patients with complex upper ureteral stones by single urologist from September 2005 to September 2011.Appropriate approaches had been selected for transurethral reteroscopic holmium laser lithotripsy(URL),minimally invasive percutaneous nephrolithotomy(MPCNL)or retroperitoneal laparoscopic ureterolithotomy(RLU) separately to compare intraoperative complications,the incidence of residual stones,operation duration,hospitalization time and cost.Results All the patients had successful operations with the stones being broken or taken out during the operations.Four cases in the URL group and three cases in the MPCNL group were converted to open surgery while three patients in the MPCNL group needed blood transfusion during the operations.Remaining stones were found in six cases in the URL group.In the URL group the patients’ operation and hospitalization time was shorter,and less cost,operation time in the MPCNL group was the longest,while highest cost in the RLU group,Comparisons among operation duration,hospitalization time and cost were statistically significant.Conclusion URL is the first choice for treatment of complicated stones at the upper ureter.It produced fewer complications,less injury,lower cost.