【摘要】 目的比较经尿道输尿管镜取石术(URL)、微创经皮肾镜取石术(MPCNL)、后腹腔镜输尿管切开取石术(RLU)及开放式输尿管切开取石术(UL)治疗复杂性输尿管上段结石的疗效。方法 137例复杂性输尿管上段结石患者按治疗方法分为4组:URL治疗46例,MPCNL治疗38例,RLU治疗29例,UL治疗24例。结果 URL组1周的结石清除率为21.7%(10/46),术后轻度肉眼血尿的发生率为43.5%(20/46),发热的发生率为10.9%(5/46),无严重并发症发生。平均住院时间为6.0 d。MPCNL组1周的结石清除率为78.9%(30/38),术后肉眼血尿的发生率为63.2%(24/38),术后发热的发生率为10.5%(4/38),平均住院时间为9.0 d。RLU组1周的结石清除率为100%,术后肉眼血尿的发生率为62.1%(18/29),发热的发生率为17.2%(5/29),无严重并发症出现,平均住院时间6.5 d。UL组术后肉眼血尿的发生率为70.8%(17/24),发热的发生率为16.7%(4/24),4例术后伤口发生感染,伤口感染发生率为16.7(4/24),4组患者的结石清除率间差异有统计学意义(χ2=72.13,P<0.05);肉眼血尿、发热的发生率间差异均无统计学意义(χ2值分别为6.20和1.12,P>0.05);平均住院时间间差异有统计学意义(F=166.7,P<0.05)。结论 RLU治疗复杂性输尿管上段结石具有结石清除率高、术后并发症少、恢复快的优点。MPC-NL、URL、RLU和UL 4种方法均可用于治疗复杂性输尿管上段结石,使用何种方法应视临床具体情况而定。更多还原

【Abstract】 Objective To compare the efficacy of ureteroscopic lithotripsy(URL),minimally invasive percutaneous nephrolithotomy(MPCNL) and retroperitoneoscopic ureterolithotomy(RLU) for the treatment of complicated upper ureteral calculi. Methods 113 patients with complicated upper ureteral calculi were classified into 4 groups,with 46 cases treated by URL,38 cases treated by mini-PCNL,29 cases by RLU and 24 cases by UL. Results The stone-free rate one week after operation in URL group was 21.73%(10/46),the incidence of slight gross hematuria was 43.5%(20/46),the incidence of fever was 10.9%(5/46),no major complications were noted,and the average hospitalization was 6 days.The stone-free rate one week after operation in MPCNL group was 92.10%(35/38),the incidence of slight gross hematuria was 63.2%(24/38),the incidence of postoperative fever was 10.52%,6 cases were obliged to accept the second-stage MPCNL for intraoperative blood loss,extravasation of irritant fluid was performed in 8 patients,1 case was obliged to accept the conservative treatment for massive hemorrhage,the average hospitalization 9 days.The stone-free rate one week after operation in RLU group was 100%,1 case was cured by open surgery,the incidence of slight gross hematuria was 62.1%(18/29),the incidence of fever was 17.2%(5/29),no major complications were noted,the average hospitalization 6.5 days.The incidence of slight gross hematuria in UL group was 70.8%(17/24),the incidence of fever was 16.7%(4/24),4 cases were found wound infection,and the infection rate was 16.7(4/24).The stone-free rate one week after operation were significantly higher in the RLU group than in the URL group and MPCNL group,the difference was statistical(χ2=72.13,P<0.05).The differences of the incidence of gross hematuria and fever were not statistical between the four groups(the value of χ2 were 6.20 and 1.12 respectively,P>0.05).The average hospitalization showed no statistical difference between the four groups(F=166.7,P>0.05).The postoperative complications were significantly higher in the MPCNL group than in the RLU group. Conclusion The RLU has advantages of high stone clearance,rare complications and speedy recovery in the treatment of complicated upper ureteral calculi.MPCNL,URL,RLU and UL can all be used in treating complicated upper ureteral calculi,and the selection should be made in accordance with actual clinical situation.更多还原