输尿管软镜、微创经皮肾镜、后腹腔镜治疗输尿管上段结石的比较研究

目的：为了提高保守治疗和体外冲击波碎石治疗失败的输尿管上段结石的治疗效果,并寻求最佳的治疗方法,研究和探讨输尿管软镜(RIRS)﹑微创经皮肾镜取石术(MPCNL)﹑后腹腔镜输尿管切开取石术(RLU)3种微创手术方法治疗输尿管上段结石的优劣。方法回顾性分析整群选取的188例于2014年1月—2016年1月来该院手术治疗的输尿管上段结石患者,根据手术治疗方法不同分为3组,分别是输尿管软镜组﹑微创经皮肾镜组﹑后腹腔镜组,探讨和研究3种不同的治疗方案疗效和安全性差异。结果经过研究发现,虽然RIRS组和MPCNL组﹑RLU组相比术后3~5 d结石清除率较低,且两组比较差异有统计学意义(P<0.05)；但术后3月结石清除率三者比较差异无统计学意义(P>0.05)；RIRS组的失血量﹑住院时间和MPCNL组相比显著降低,且两组患者比较差异有统计学意义(P<0.05),而RIRS组和RLU组对比手术用时明显缩短且两组患者比较差异有统计学意义(P<0.05),3组术后3月结石清除率﹑手术并发症比较差异无统计学意义(P>0.05)。结论输尿管上段结石的治疗方案要根据患者结石和全身情况综合考虑。输尿管软镜治疗输尿管上段结石的清石清除率较低,必须根据患者的具体病情况和综合条件进行选择,但输尿管软镜具有损伤小﹑步骤简单﹑易同时处理双侧结石﹑住院时间短等优点,逐渐成为输尿管结石的首选手术治疗方案。微创经皮肾镜目前仍可作为输尿管上段结石治疗的常用方案, RLU的清石效果和传统开放手术大致相同,值得应用。

A Comparative Study on the Treatment of Retrograde Intrarenal Surgery,Minimally Ivasive Percutaneous Nephrolithotomy and Retroperitoneal La-paroscopic Ureterolithotomy

Objective To improve the therapeutic effect of upper ureteral calculi which failed in conservative therapy and extracorporeal shock wave lithotripsy treatment and seek the best treatment method, study and explore the pros and cons of retrograde intrarenal surgery(RIRS), minimally ivasive percutaneous nephrolithotomy(MPCNL), retroperitoneal laparoscopic ureterolithotomy (RLU) three kinds of minimally invasive surgical method of the upper ureteral calculi. Methods Group se-lection retrospective analysis of 188 cases of upper ureteral calculi patients surgically treated in our hospital from January 2014 to 2016 January which were divided into 3 groups according to different surgical treatment, respectively is RIRS group (n=51), MPCNL group (n=73) and RLU group (n=64), to explore and study the efficacy and safety of three different treat-ments. Results It was found from the study that compared with MPCNL group and RLU group, the stone clearance rate of 3~5 days after operation was lower in RIRS group and there was a significant difference (P<0.05),but the stone clearance rate of 3 months after operation has no difference and there was no statistically significant difference (P<0.05);The blood loss and hospitalization time were significantly lower in the RIRS group compared with MPCNL group, and the difference was statis-tical (P<0.05), the operation time significantly shortened in RIRS group and RLU group compared with MPCNL group, and the difference were statistically significant (P< 0.05),there was no significant difference and no statistical significance (P>0.05) of the stone clearance rate of 3 months after operation and surgical complications in three groups. Conclusion The treatment of upper ureteral calculi should be considered in accordance with the stones and the general situation of the pa-tients. The stone clearance rate of upper ureteral calculi is relatively low in RIRS, so RIRS must be choosed according to the patient's specific condition and our condition, but RIRS has the advantages of less injury , simple steps, easy to handle bilateral calculi, and short hospitalization time etc. Gradually RIRS becomes the first choice of surgical treatment of the upper ureteral calculi. MPCNL can still be used as a common treatment of upper ureteral calculi.RLU stone clearance effect is roughly the same as the traditional open surgery, and it is worth using.