后腹腔镜与微通道经皮肾镜治疗嵌顿性输尿管上段结石的疗效比较

目的比较后腹腔镜输尿管切开取石术（RLU）与微通道经皮肾镜取石术（MPCNL）治疗输尿管上段嵌顿性结石的有效性和安全性。方法回顾性分析平煤总医院2008年7月-2012年7月共154例单侧嵌顿性输尿管上段结石患者的临床资料，其中60蜥后腹腔镜手术（RLU）取石，94例行微通道经皮肾镜（MPCNL）治疗，对比二组间手术时间、术中出血、结石取净率、术后高热（体温〉38℃）、住院时间等。结果RLu组手术时间为（85．4±17．6）min，长于MPCNL组（70．2±20．1）min（P〈0．05）；术中出血量MPCNL组平均（100±14）ml，高于RLU组（40±13）ml（P〈0．05）；手术后结石清除率MPCNL组为96％（90／94），RLU组为100％（60／60），差异无统计学意义（P〉0．05）；术后发热二组差异无统计学意义（P〉0．05），住院费用RLU组为（8023．70±1231．23）元，MPCNL组为（11184．25±1325．75）元，差异有统计学意义（P〈0．05）。结论MPCNL、RLU均在治疗输尿管上段结石上有满意的疗效与安全性；使用何种方法视临床具体情况而定。

COMPARISON OF RETROPERITONEAL LAPAROSCOPIC URETEROLITHOTOMY AND MINIMALLY INVASIVE PERCUTANEOUS NEPHROLITHOTOMY FOR IMPACTED UPPER URETERAL

Objective To compare the efficacy and safety of retroperitoneal laparoscopic ureterolithotomy （RLU） and minimally invasive percutaneous nephrolithotomy（MPCNL） in the management of impacted proximal ureteral stones. Methods A total of 154 patients with unilateral upper ureteral calculi were treated with MPCNL or RLU. The operation time, blood loss during operation, clearance rate of the stone, incidence of postoperative hyperpyrexia, hospitalization time and expense were statistically analyzed. Results The mean operation time in RLU group was （85.4 ± 17.6）min, which was longer than that in MPCNL group （70.2 ± 20. lmin） ; The mean intraoperative blood loss in MPCNL group was （100 ± 14）ml, which was higher than that in RLU group （40 ± 13ml） ; The stone clearance rate of MPCNL group and RLU group was 96% （90/94） and 100% （60/60）, but there was no significant difference between the two groups （P〈0.05）. There was also no significant difference in the incidence of postoperative hyperpyrexia between two groups（P〈0.05）. The mean hospitalization expense in MPCNL group was （11 184.25 ± 1 325.75） yuan, which was higher than that in RLU group（8 023.70 ± 1 231.23）yuan（P〈0.05）. Conclusion Both MPCNL and RLU are effective and safe for patients with complicated upper ureteral calculi.