复杂性输尿管上段结石的微创治疗选择

目的比较4种微创方式处理复杂性输尿管上段结石的疗效,探讨治疗复杂性输尿管上段结石的合理选择。方法回顾性分析武汉大学人民医院2008年2月—2011年1月403例复杂性输尿管上段结石患者的临床资料,依据体外冲击波碎石术(ESWL)、经尿道输尿管镜碎石术(URL)、微创经皮肾镜取石术(MPCNL)及后腹腔镜输尿管切开取石术(RLU)进行分组,比较患者临床资料及各组间的手术成功率、结石清除率、并发症发生率、住院时间及治疗费用。结果 403例患者中,ESWL治疗78例,URL 136例,MPCNL 103例,RLU 86例;一次治疗成功率ESWL组为41.0%,URL组为71.3%,MPCNL组为87.4%,RLU组为97.7%;术后1个月结石清除率ESWL组为69.2%,URL组为85.3%,MPCNL组为96.1%,RLU组为100.0%;住院时间ESWL组为(4.5±1.9)d,URL组为(6.5±2.1)d,MPCNL组为(9.6±1.9)d,RLU组为(9.1±2.2)d;治疗费用ESWL组为(3 947±721)元,URL组为(7 682±937)元,MPCNL组为(12 613±1 342)元,RLU组为(13 284±1 830)元;严重并发症发生率ESWL组为零,URL组为1.5%,MPCNL组为1.0%,RLU组为零。结论 4种方法均可用于治疗复杂性输尿管上段结石,ESWL和URL治疗时间短,损伤小,MPCNL和RLU治疗时间长,结石清除率及治疗费用均较高,应根据患者的临床情况和实际要求制定相应的治疗方案。

Options of minimally invasive treatment for complicated upper ureteral calculi

Objective]To compare the efficacy of four kinds of minimally invasive treatment for complicated upper ureteral calculi,study the reasonable treatment option for the patient with complicated upper ureteral calculi.Methods]The clinical data of 403 patients with complicated upper ureteral calculi in Renmin Hospital of Wuhan University from February 2008 to January 2011 were retrospectively analyzed.The patients were divided into four groups,which included extracorporeal shock wave lithotripsy（ESWL） group,ureteroscopic lithotripsy（URL） group,minimally invasive percutaneous nephrolithotomy（MPCNL） group and retroperitoneal laparoscopic ureterotomy（RLU） group.The operation success rate,stone-free rate,incidence rate of complications,hospital stay and treatment cost of four groups were analyzed.Results]Among 403 patients,78 cases were treated with ESWL,136 cases with URL,103 cases with MPCNL and 86 cases with RLU.The first operation success rate of ESWL group,URL group,MPCNL group and RLU group was 41.0%,71.3%,87.4% and 97.7%,respectively.One month after the operation,stone-free rate of ESWL group,URL group,MPCNL group and RLU group was 69.2%,85.3%,96.1% and 100%,respectively.The hospital stay of ESWL group,URL group,MPCNL group and RLU group was（4.5±1.9） d,（6.5±2.1） d,（9.6±1.9） d and（9.1±2.2） d,respectively.The treatment cost of ESWL group,URL group,MPCNL group and RLU group was（3 947±721） Yuan,（7682±937） Yuan,（12 613±1342） Yuan and（13 284±1 830） Yuan,respectively.The incidence rate of serious complications of ESWL group,URL group,MPCNL group and RLU group was 0,1.5%,1.0% and 0,respectively.Conclusion]All of four methods can be used for the treatment of complicated upper ureteral calculi.ESWL and URL have shorter treatment time and less damage.MPCNL and RLU have longer treatment time,higher stone-free rate and more costs.The best therapy should be adopted according to the patient＇s clinic condition and actual demand.