3种微创方法治疗复杂性输尿管上段结石的比较

目的：探讨复杂性输尿管上段结石的有效治疗方法。方法：回顾性分析逆行输尿管镜（URL）、微创经皮肾镜碎石术（MPCNL）以及后腹腔镜输尿管切开取石术（RLU）治疗复杂性输尿管上段结石患者的临床效果,比较3种治疗方法的成功率、碎石清除率及并发症。结果：210例患者中,URL治疗103例,1次手术成功率88.5%（91/103）,11例输尿管输尿管镜无法到达结石部位,1例输尿管穿孔损伤改开放手术,术后1月结石清除率为85.0%。MPCNL治疗92例,1次手术成功率为92.4%（85/92）,5例肾穿刺失败改开放手术,2例术中出血较多改2期手术,结石清除率为98.0%,并发症发生率为4.0%。RLU治疗15例,1次手术成功率为100%,结石1次取尽,无并发症。结论：3种微创手术方式皆有较好的疗效,各有优缺点,应根据患者临床需求及医院实际情况选择治疗方案。

Comparision of three mini-invasive treatments for complicated upper ureteric calculi

Objective:To explore the treatment for complicated upper ureteric calculi. Methods: Retrospectively analyzed clinic effect of retrograde ureteroscope (URL),mini-invasive percutaneous nephrolithotomy (MPCNL) and laparoscopic ureterolithotomy (RLU) on complicated upper ureteric calculi,compared the success rate,clearance and complication occurrence in patients with different treatment. Results: Out of 210 patients,103 were treated by URL,in which 11 cases had ureteroscope failed in arriving ureteric calculi and 1 case had opening surgery due to ureteral perforation,with success rate for once surgery as 88.5% (91/103) and clearance after 1 month as 85.0%. 92 were treated by MPCNL,in which 2 cases had the second surgery due to over bleeding during operation and 5 cases had opening surgery due to renal biopsy failure,with success rate for once surgery as 98.0% (85/92),clearance as 98.0% and complication occurrence as 7.0%. 15 were treated by RLU,with ureteric calculi cleared for once and success rate for once surgery as 100.0%,and without complication. Conclusion: With their own characters,three mini-invisive surgery methods are all effective. It is valuable to select therapy based on patients' need and situation of hospital.