三种微创方法治疗输尿管上段结石的对照分析

目的探讨治疗输尿管上段结石的最佳方法。方法回顾分析170例输尿管上段结石患者临床资料，51例采用经尿道输尿管镜下碎石术（ureteroscope recessive lithotrity，URL），57例采用微创经皮肾输尿管镜碎石术（minimally invasive percutane nephrolithotomy，MPCNL），62例采用后腹腔镜下输尿管切开取石术治疗，并比较分析三种手术的治疗效果。结果术后3d、1月结石清除率三组分别为：URL组33．3％（17／51）、90．2％（46／51），MPCNL组94．7％（54／57）、98．2％（56／57），后腹腔镜下输尿管切开取石术组98．4％（61／62）、100％（62／62）；URL组显著低于后两组（P〈0．05），而后两组之间无显著差异。结论MPCNL与后腹腔镜下输尿管切开取石治疗输尿管上段结石均有很高的结石清除率，URL效果较差。

Comparative analysis of three minimally invasive managements for upper ureteral calculi

Objective To discuss the best method for upper ureteral calculi. Methods The data of 170 patients who had upper levels of ureteral stones were retrospectively reviewed. 51 of them accepted transurethral ureteroscopic lithotripsy （URL）, 57 minimally invasive percutane nephrolithotomy （MPCNL）, and 62 retroperitoneal laparoscopic ureterlithotomy. The treatment results of the three kinds of surgical operations were compared and analyzed. Results The stone-free rate was recorded 3 days and 1 month postoperation. The stone-free rate was 33.3% （17/51） and 90.2% （46/51） for URL; 94.7% （54/57） and 98. 2% （56/57） for MPCNL, and 98. 4% （61/62） and 100% （62/62） for retroperitoneal laparoscopic ureterlithotomy. Stone-free rate of URL was lower than the other two methods, which had, no difference. Conclusion High stone-free rate can be obtained with minimally invasive percutane nephrolithotomy and retroperitoneal laparoscopic ureterlithotomy for impacted upper ureteral calculi. The stone-free rate is less satisfactory with transurethral ureteroscopic lithotripsy.