RPLU、FURL及PCNL治疗输尿管上段嵌顿性结石的疗效研究

目的探讨后腹腔镜切开取石术（retroperitoneal laparoscopic lithotomy,RPLU）、输尿管软镜碎石清石术（lithotripsy with flexible ureteroscope,FURL）及经皮肾镜碎石清石术（percutaneous nephrolithotomy,PCNL）种不同方法治疗输尿管上段嵌顿性结石的疗效,以明确直径大于1.5 cm的输尿管上段嵌顿性结石的最佳处理方案。方法回顾性分析159例输尿管上段嵌顿性结石,收集其术前术中资料,按术式不同分为RPLU组56例、FURL组55例、PCNL组48例。对手术时间、术后住院时间、结石清除率、术后并发症等数据进行统计学分析。结果FURL组手术时间和术后住院时间明显短于RPLU组和PCNL组,差异均有统计学意义（P＜0.05）。RPLU组术后3 d和术后1个月的结石清除率（100%,100%）稍高于FURL组（90.9%,94.5%）和PCNL组（93.8%,93.8%）,3组患者术后无严重并发症出现,差异均无统计学意义（P＞0.05）。结论3种不同手术方法治疗嵌顿性输尿管上段结石均安全有效,FURL组手术时间及住院时间更短,患者术后恢复更快,更具有优势。

Retroperitoneal laparoscopic lithotomy,flexible ureteroscopic lithotripsy and percutaneous nephrolithotomy in the treatment of impacted upper ureteral calculi

ObjectiveTo investigate the effect and to determine the best treatment among the three method of retroperitoneal laparoscopic lithotomy(RPLU), lithotripsy with flexible ureteroscope(FURL) and percutaneous nephrolithotomy(PCNL) in the treatment of impacted upper ureteral calculi larger than 1.5 cm.MethodsOne hundred and fifty-nine cases of upper ureteral impacted calculi were retrospectively analyzed. The preoperative and intraoperative data were collected and the cases were divided into RPLU group(56 cases), FURL group(55 cases) and PCNL group(48 cases) according to different operation style. The operation time, postoperative hospital stay, stone clearance rate and postoperative complications were statistically analyzed.ResultsThe operation time and postoperative hospital stay in FURL group were significantly shorter than those in RPLU group and PCNL group(P＜0.05). The stone clearance rate of RPLU group(100%, 100%) was slightly higher than that of FURL group(90.9%, 94.5%) and PCNL group(93.8%, 93.8%) at 3 days and 1 month after operation, but the differences were not statistically significant(P＞0.05). There were no serious complications in the three groups.ConclusionIt shows that the three Methodsare safe and effective in the treatment of incarcerated upper ureteral calculi. The FURL group has the advantages in shorter operation time and hospitalization stay, and the patients recover faster after operation, compared with other two Methods.