3种微创手术治疗嵌顿性输尿管上段结石疗效比较  

Comparison of three kinds of minimally invasive lithotripsy for treatment of impacted upper-ureteral calculi

作　　者：陈书练[1] 付逆[1] 崔伟[1] 苗向阳[1] 吴涛[1] 罗旭[1] 

机构地区：[1]遵义医学院附属医院泌尿外科,贵州遵义563099

出　　处：《遵义医学院学报》2013年第3期239-241,245,共4页Journal of Zunyi Medical University

摘　　要：目的比较经尿道输尿管镜碎石术(URL)、微创经皮肾输尿管镜碎石术(MPCNL)以及后腹腔镜输尿管切开取石术(RLUL)治疗嵌顿性输尿管上段结石的疗效。方法回顾分析遵义医学院附属医院收治的连续单侧嵌顿性输尿管上段结石患者150例临床资料,比较3种方法的术前结石大小、肾积水程度、碎石成功率、手术时间、平均术后住院时间、手术并发症、术后3 d及1月时结石清除率。结果 URL组术后3 d和1月结石清除率分别为75.0%和91.1%、MPCNL组分别为98.0%和100%、RLUL组均为100%。术后3 d的比较URL组结石清除率组明显低于MPCNL和RLUL组,差异有统计学意义(P<0.01),术后1月结石清除率的比较URL组低于MPCNL和RLUL组,差异有统计学意义(P<0.05),术后3 d及1月结石清除率的比较,MPCNL组与RLUL组差异无统计学意义(P>0.05)。结论嵌顿性输尿管上段结石,URL仍可为其主要治疗手段,术后联合体外冲击波碎石治疗可提高结石清除率;在技术成熟的医院,部分病例可选择MPCNL及RLUL治疗。Objective To compare the effects of the minimally invasive transurethral ureteroscope litho- tripsy （URL）, percutaneous nephrolithotomy （MPCNL） and retroperitoneal laparoscopic ureterolithoto- my （RLUL） in impacted upper - ureteral calculi treatment. Methods One hundred and fifty cases of im- pacted upper - ureteral calculi were collected and analyzed retrospectively. After three types of minimal- ly invasive lithotripsy treatment, the preoperative stone size, the degree of hydronephrosis, the success rate of lithotripsy, the operation time, the average postoperative hospitalization time, the complications of operation, the stone free rate three days and one month after operation were compared. Results In URL group, the stone free rates three days and one month after operation were 75.0% and 91.1% , re- spectively. In MPCNL group, the stone free rates three days and one month after operation were 98% and 100%, respectively. In RLUL group, the stone free rate was 100% in three days and one month af- ter operation. The stone free rate three days and one month after operation in URL group was lower than that in MPCNL and RLUL groups, whereas there was no significant difference of the stone free rate three days and one month after operation between MPCNL and RLUL groups. Conclusion URL might be a ma- jor choice for impacted upper - ureteral calculi treatment and URL combined with ESWL after operation could increase the stone free rates. MPCNL and RLUL can be alternative therapeutic treatment in ad- vanced hospitals.

关 键 词：输尿管上段结石 微创经皮肾镜 输尿管镜 腹腔镜 

分 类 号：R693[医药卫生—泌尿科学]