不同微创取石术式治疗复杂性输尿管上段结石近远期疗效、安全性及经济性比较

摘要

Objective:To investigate the clinical effects,safety and economical efficiency differences in tran-surethral ureteroscope lithotripsy (URL),minimally invasive percutaneous nephrolithotomy (MPCNL)and retro-peritoneoscopic ureterolithotomy (RLU)in the treatment of complex upper ureteral calculi.Methods:150 patients with complex upper ureteral calculi were chosen in the period from June 2012 to June 2015 in our hospital and ran-domly divided into three groups:group A (n=50)receiving URL,group B (n=50)receiving MPCNL,and group C (n=50)given RLU.The perioperative clinical indicators,once disposable stone clearance rate,the post-operative complication incidence and the total treatment expenses among three groups were compared.Results:The operation time in group C was significantly longer than in group A and group B (P<0.05).The blood loss in group B was significantly less than in group A and group C (P<0.05).The once stone clearance rate in group B and group C was significantly higher than in group A (P<0.05).The postoperative complication incidence in group C was significantly lower than in group A and group B (P<0.05).The total treatment expenses in group C was significantly lower than in group A and group B (P<0.05).Conclusions:Compared with URL and MPCNL, RLU in the treatment of complex upper ureteral calculi can efficiently improve stone clearance effects,reduce the risk of postoperative complications and be helpful to lessen the financial burden.%目的：：探讨经尿道输尿管镜激光取石术、经皮肾穿刺取石术及后腹腔镜切开取石术治疗复杂性输尿管上段结石临床疗效、安全性及经济性差异。方法：研究对象选取2012年6月~2015年6月收治复杂性输尿管上段结石患者共150例，采用随机区组法分为A组(50例)、B组(50例)及C组(50例)，分别行经尿道输尿管镜激光取石术、经皮肾穿刺取石术及后腹腔镜切开取石术治疗；比较三组患者围手术期临床指标、一次性结石清除率、术后并发症发生率及总治疗费用等。结果：C组患者手术时间均显著长于 A、B组，差异有统计学意义(P＜0.05)；B组患者术中出血量均显著多于 A、C组，差异有统计学意义(P＜0.05)；B组和 C组患者一次性结石清除率显著高于A组，差异有统计学意义(P＜0.05)；C组患者术后并发症发生率显著低于A、B组，差异有统计学意义(P＜0.05)；C组患者总治疗费用显著低于 A、B组，差异有统计学意义(P＜0.05)。结论：后腹腔镜切开取石术治疗复杂性输尿管上段结石可显著提高结石清除效果，降低术后并发症发生率，并有助于减少治疗费用，临床价值优于经尿道输尿管镜激光取石术和经皮肾穿刺取石术。