三种腔镜治疗输尿管上段结石的比较

目的：比较微创经皮肾镜取石术（minimally invasive percutane nephrolithotomy，MPCNL）、输尿管镜取石术（ureteroscope recessive lithotrity,URL）后腹镜榆尿管切开取石术（retroperitoneal laparoscopic ureterolithotomy）3种腔镜治疗输尿管上段结石的疗效。方法：从2006年1月至2008年12月，对130例单侧输尿管上段结石患者，55例采用MPCNL治疗，39例采用URL治疗后，36例采用后腹腔镜输尿管切开取石治疗。结果：MPCNL组临床治疗成功率为100％（55／55），一次结石清除率为94．5％（52／55），平均手术时间45min。URL组临床治疗成功率为82％（22／39），术后一次结石清除率46％（18139），术后辅助体外冲击波碎石，1个月结石清除率为82％（32，39），平均手术时间35min。后腹腔镜组36例。29例成功取尽结石，手术成功率80％（29／36），7例中转开放手术，平均手术时间75min。MPCNL一次取净结石率显著高于URL组及后腹腔镜组（P〈0．05）。结论：微创经皮肾穿刺碎石治疗输尿管上段结石，有较高的临床治疗成功率、结石清除率。虽然经尿道输尿管镜碎石治疗效果较差，但联合体外冲击渡可提高疗效。后腹腔镜在提高腔镜技术后，手术时间明显缩短，手术成功率明显提高。

The Comparison of the Treatment of Three Types of Laparoscopic to Upper Ureteral Calculi

Objective：To compare the effect of the three types of laparoscopic to upper ureteral calculi,the three types are minimally invasive pereutane nephrolithotomy （MPCNL）, ureteroscope recessive lithotrity（URL ）, retroperitoneal laparoscopic ureterolithotomy.Method：To treat 55 cases of unilateral ureteral calculi patients with MPCNL,39 patients with URL,and 36 cases with retroperitoneal laparoseopie ureterolithoto- my,a total of 130 cases.Result：The clinical success rate and the stone clearance rate of MPCNL group is 100% and 94.5%, the average operation time is 45 min.While the same rate in URL group is 82% and 46%, then aid ESWL after the surgery and the stone clearance rate is 82% in a month,the average operation time is 35 min.There are totall 36 cases in the laparoscopic group,among them ,29 eases of stones were removed successfullyand 7 cases were conveyed to open surgery,the success rate is 80% and the average operation time is 75 rain. MPCNL group is significantly higher than the URL and the laparoscopic group in removing off the storte.. Conclusion：It has a higher clinical success rate and stone clearance rate of minimally invasive percutaneous lithotripsy for ureterai stones. Although ureteroscopie lithotripsy in the treatment is less effective, commonwealth of extracorporeal shock wave can improve the efficacy. After improve the laparoscopic techniques, the operative time is significantly shorter and urgical success rate is significantly increased.