复杂性输尿管上段结石的两种微创手术方法的疗效比较

目的： 比较经皮肾镜取石术（percutaneous nephrolithotomy,PCNL）和后腹腔镜下输尿管切开取石术（retroperitoneal laparoscopic ureterolithotomy ,RLU）治疗复杂性输尿管上段结石的疗效。方法： 回顾性分析71例复杂性输尿管上段结石患者临床资料，PCNL组31例和RLU组40例，对比两组病例手术时间、术后1周结石清除率、手术并发症。结果： 71例手术全部成功，手术时间PCNL组（48.52±17.51 ）min]短于RLU组（87.43±22.63）min]，差异有统计学意义(P<0.01)。术后1周结石清除率PCNL组为96.8%（30/31），RLU组100%（40/40），两组比较差异无统计学意义(P>0.05)。术中、术后均无明显出血及周围脏器损伤等并发症。术后随访3~10个月，平均7个月，两组均未发现结石复发及输尿管狭窄。结论： PCNL和RLU治疗复杂性输尿管上段结石均是安全、有效的方法。复杂性输尿管上段结石的治疗可视患者具体情况、单位设备条件、术者经验酌情选择PCNL或RLU。

Comparison of two minimally invasive methods for complicated upper ureteric calculi

Objective: To evaluate the effect of the percutaneous nephrolithotomy(PCNL) in the management of complicated upper ureteric calculi,comparing with retroperitoneal laparoscopic ureterolithotomy(RLU).Methods: Seventy-one cases with complicated upper ureteric calculi were retrospectively investigated(PCNL group 31 cases,RLU group 40 cases).Clinical data including operation time,stone free rate and the surgical complications were statistically analyzed.Results: All the operations were successful in all 71 cases.As compared to the RLU group,the PCNL group had a significant shorter operation time (48.52±17.51) min vs(87.43±22.63)min,P<0.01],and significant difference were detected.A week after the operation,the PCNL group showed a stone free rate of 96.8%(30/31) while the RLU group 100%(40/40),and no significant difference were detected.No significant complications,such as intraoperative or postoperative bleeding and damage to surrounding organs,were detected.The patients were followed up for 3 to 10 months(mean,7 months),and no recurrent stones or ureteral stricture were developed during the period.Conclusion: Both PCNL and RLU are safe and effective for complicated upper ureteral calculi.The appropriate method depends on the patients′ specific conditions,the unit equipments and the experience of operator.