三种腔镜技术治疗复杂性输尿管上段结石的疗效比较  

Comparison of the Three Minimally Invasive Surgical Treatments for Complicated Upper Ureteral Calculi

作　　者：毛峥[1] 商庆兵 王婵[1] 张平[1] 余洋[1] 董自强[1] 

机构地区：[1]三峡大学第一临床医学院泌尿外科,湖北宜昌443003 [2]宜昌军分区医院泌尿外科

出　　处：《临床泌尿外科杂志》2010年第8期595-598,共4页Journal of Clinical Urology

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(MPCNL)、后腹腔镜输尿管切开取石术(RLU)治疗复杂性输尿管上段结石的疗效。方法:113例复杂性输尿管上段结石患者按治疗方法分为三组:URL组46例,MPCNL组38例,RLU组29例。结果:URL组一周结石清除率21.74%(10/46),无严重并发症发生,平均住院6天。MPCNL组1周结石清除率92.10%(35/38),术后发热10.52%,6例因术中出血,改为二期取石,手术成功;8例术中冲洗液外渗,1例大出血行保守治疗好转,平均住院9天。RLU组有1例转开放取石,一周结石清除率100%,无严重并发症出现,平均住院6.5天。RLU组的一周结石清除率显著高于URL及MPCNL组,术后并发症发生率明显低于MPCNL。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。MPCNL、URL和RLU三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。Objective：To compare the efficacy of three procedures, ureteroscopic lithotripsy （URL）, minimally invasive percutaneous nephrolithotomy （MPCNL）, and retroperitoneoscopic ureterolithotomy （RLU）, for the treatment of complicated upper nreteral calculi. Methods： 113 cases of complicated upper ureteral calculi were clas sified into 3 group s, 46 cases of united group treated by URL, 38 cases of mini PCNL group treated by mini-PCNL, and 29 cases of RLU group treated by RLU. Results：The stone-free rate of one week after operation in URL group was 21.74% （10/46）, no major complications were noted. The average hospitalization 6 days. The stone-free rate of one week after operation in MPCNL group was 92.10%（35/38） , postoperative fever 10. 52%, 6 cases were obliged to accept the second-stage MPCNL for intraoperative blood loss, extravasation of irrigant fluid was performed in 8 patient, 1 cases was obliged to accept the conservative treatment for massive hemorrhage, the average hospitalization 9 days. The stone-free rate of one week after operation in RLU group was 100%, 1 case was treated by open surgery, no major complications were noted, the average hospitalization 6.5 days. The stone- free rate of one week were significantly higher in the RLU cases than in the URL cases and MPCNL cases. The postoperative complications were significantly higher in the MPCNL cases than in the RLU cases. Conclusions：The RLU which is cured the complicated upper ureteral calculi have advantages of high stone clearance, rare complications, speedy recovery. Three minimally invasive surgical treatments all are used for complicated upper ureteral calculi, according to the practical situation we choose the suitable means.

关 键 词：输尿管结石 治疗 

分 类 号：R693.4[医药卫生—泌尿科学]