上段输尿管结石3种微创治疗方法的比较

目的比较输尿管镜气压弹道碎石术、输尿管钬激光碎石术及后腹腔镜下输尿管上段切开取石术对输尿管上段结石的治疗效果,探讨治疗输尿管上段结石的最佳方法。方法回顾性分析130例输尿管上段结石患者临床资料,其中38例采用输尿管镜气压弹道碎石术（PL组）,45例采用输尿镜钬激光碎石术（LL组）,47例采用后腹腔镜下输尿管上段切开取石术（RLU组）治疗。对三组结石清除率行统计学分析,比较三种微创方法的治疗效果。结果术后1周,三组结石清除率分别为：PL组78.9%（30/38）,LL组95.6%（43/45）,RLU组100%（47/47）。LL组及RLU组结石清除率明显高于PL组,差异有统计学意义（P〈0.025）;LL组及RLU组结石清除率差异无统计学意义（P〉0.05）。结论输尿管镜钬激光碎石术及后腹腔镜下输尿管上段切开取石术创伤小,结石清除率高、并发症少,是治疗输尿管上段结石一种安全有效的微创治疗方法,但后腹腔镜下输尿管上段切开取石术需要全面的腹腔镜技术训练。

Comparasion of three minimally invasive treatment for upper ureteral calculi

Objective To compare pneumatic lithotripsy,uretroscopic Holmium laser lithotripsy and retroperitoheoscopic ureterolithotomy for the treatment of upper ureteral calculi.Methods 130 cases of upper-ureteral calculi were analyzed retrospectively.38,45 and 47 cases were managed with pneumatic lithotripsy（PL group）,uretroscopic Holmium laser lithotripsy（LL group）,and retroperitoneal laparoscopic ureterolithotomy（RLU group） respectively.One-session stone clearance rate was analyzed statistically.Results The free one-session stone clearance rate of PL、LL、RLU group was 78.9%（30/38）,95.6%（43/45）and 100%（47/47）respectively.The stone free rate of LL and RLU were significantly higher than that of PL（P0.025）.The stone free rate between LL and RLU showed no significant difference（P0.05）.Conclusions LL and RLU are safe,efficient and microinvasive managements for upper-ureteral calculi with minimal injuries,while RLU needs a comprehensive training to perform.