上段输尿管结石三种微创治疗方法的比较

目的：探讨治疗上段输尿管结石的最佳方法。方法：对我院经微创经皮肾镜取石术（MPCNL）、输尿管镜下碎石术（URL）及后腹腔镜下输尿管上段切开取石术（RLU）三种方法治疗的167例上段输尿管结石患者疗效进行比较。结果：行MPCNL术82例，一次碎石率为96．3％；行URL术59例，一次碎石率为83．1％；行RLU术26例，取石成功率为100％。MPCNL术中有2例因穿刺后出血改行2期MPCNL术，1例因结石下移改行输尿管镜下碎石术。URL术中碎石失败改行切开取石术5例，结石移位到肾盂改行MPCNL术5例。结论：RLU术是一种微创且有效的方法，但需要全面的腹腔镜技术训练。MPCNL术已成为治疗上段输尿管结石的主流技术和最佳方法。URL术不作为上段输尿管结石治疗的首选方法。输尿管切开取石术虽然创伤大，但是一切输尿管手术的基础。

Comparative Study of Three Various Minimally Invasive Means for the Treatment of Upper Ureteral Calculi

Objective：To evaluate the best means for the treatment of upper ureteral calculi. Methods：The three treatments of 167 cases with upper ureteral calculi including minimally invasive percutaneous nephrolithotomy （MPCNL）, ureteroscopic lithotripsy （URL） and retroperitoneoscopic ureterolithotomy （RLU） were compared. Results：82 cases were treated by MPCNL, the rate of one-time gravel was 96.3%. 59 cases were treated by URL, and the rate of one-time gravel was 83.1%. 26 cases were treated by RLU, and the success rate of stone remove was 100%. 2 cases were obliged to accept the second MPCNL because of blood after puncture. 1 case was obliged to accept ureteroscopic lithotripsy because the stone went down. 5 cases were obliged to accept the open surgery because the ureteroscopic lithotripsy was failure. 5 cases were obliged to MPCNL because the stone moved to the renal pelvis. Conclusions：RLU is an efficient minimally invasive surgical technique, but it needs a comprehensive technical training of laparoseopic. MPCNL is becoming the important technology and the best method for upper u- reteral calculi because of its good effect. URL was not suitable for upper ureteral calculi. Although with large trauma, ureterolithotomy is the base of all ureteral operation.