微创手术治疗复杂性输尿管上段结石疗效观察

目的观察经皮。肾镜取石术（PCNL）与后腹腔镜下输尿管切开取石术（RLU）治疗复杂性输尿管上段结石的临床效果。方法回顾性分析52例复杂性输尿管上段结石患者临床资料，其中采用PCNL治疗23例（PCNL组）和采用RLU治疗29例（RLU组），比较两组手术时间、术后1周结石清除率、手术并发症等。结果52例手术全部成功。手术时间：PCNL组（45．12±11．56）min]短于RLU组（82．03±12．45）min]（t=10．13，P〈0．01）。术后1周结石清除率PCNL组为95．6％（22／23），RLU组100．0％（29／29），两组差异无统计学意义（P〉0．05）。术中、术后均无明显出血及周围脏器损伤等并发症。术后随访6—12个月，平均9个月，两组均未发现结石复发及输尿管狭窄。结论PCNL与RLU治疗复杂性输尿管上段结石均是安全、有效的方法，可视患者具体情况、单位设备条件、术者经验酌情选择。

Evaluation of minimally invasive surgical treatment of the complicated upper ureteric calculi

Objective To evaluate the effect of the percutaneous nephrolithotomy （PCNL） in the manage- ment of complicated upper ureterie calculi, compared with retroperitoneal laparoscopie ureterolithotomy （RLU）. Methods Seventy-one cases with complicated upper ureteric calculi were retrospectively investigated （PCNL group 23 cases, RLU group 29 eases）. Clinical data including operation time, stone free rate and the surgical complications were statistically analyzed. Results , All the operations were successful in all 52 cases. Compared with the RLU group, the PCNL group had a significant shorter operation time （45.12 ± 11.56 ） min vs （ 82.03 ± 12.45 ） min, t = 10.13 ,P 〈 0.01 ] , and significant difference were detected. A week after the operation, the PCNL group showed a stone free rate of 95.6% （22/23） while the RLU group 100.0% （29/29）, and no significant difference were detec- ted. No significant complications, such as intraoperative or postoperative bleeding and damage to surrounding organs, were detected. The patients were followed up for 6 to 12 months （mean,9 months） , and no recurrent stones or ureteral stricture were developed during the period. Conclusion Both PCNL and RLU are safe and effective for complicated upper ureteral calculi. The appropriate method depends on the patients＇ specific conditions,the unit equipments and the experience of operator.