三种微创手术方法治疗伴有中重度肾积水的输尿管上段大结石的优劣比较

摘要

目的：比较输尿管镜取石术( URSL)、微创经皮肾镜取石术( MPCNL)及后腹腔镜输尿管切开取石术( RPLU)治疗伴有中重度肾积水的输尿管上段大结石的优劣性。方法回顾性分析本院收治的伴有中重度肾积水的输尿管上段结石患者65例，按手术方式分为3组：URSL组(21例)、MPCNL组(24例)、RPLU组(20例)，比较不同手术方式的手术时间、平均住院日、术中出血量、术后结石残余率、并发症发生率等进行统计学分析。结果后腹腔镜组的手术时间(93.85±6.35 min)长于输尿管镜组(44.19±6.45 min)和经皮肾镜组(51.12±11.20 min)(P<0.05)；经皮肾镜组的Hb下降值(12.83±8.20 g/L)明显高于输尿管镜组(4.95±2.65 g/L)和后腹腔镜组(5.50±3.17 g/L)( P<0.05)；输尿管镜组的术后住院时间(2.80±0.68天)短于经皮肾镜组(5.50±1.38天)和 RPLU 组(4.95±0.83天)(P<0.05)；残石率从高到低依次为：输尿管镜组、经皮肾镜组、后腹腔镜组；但并发症方面，三组间无差异。结论 URSL、MPCNL及RPLU三种微创手术方法均有满意的疗效及安全性，各有其优势和劣势，但从治疗效果方面，推荐MPCNL及RPLU。%Objective To compare the advantage and inferiority among ureteroscopic lithotripsy (URSL),minimally invasive percutaneous nephro1ithotomy(MPCNL) and retroperitonea1 laparoscopic ureterolithotomyin (RPLU) for treatment of proximal ureteral calculi. Method Retrospective investigation and analysis were carried out in 65 cases of patients with upper ureteral calculi accompanied by moderate or severe kidney seeper.These cases were divided into three groups according to three kinds of operations they received:URSL group (n=21),MPCNL group (n=24),RPLU group (n=20).Then five in￣dexes,namely durations of operation,average hospitalization days,amounts of blooding in operations,residue rates of calculus after operation;incidence rates of complications were compared. Results The operation time of RPLU group(93.85±6.35 min) was more longer than that of URSL group(44.19±6.45 min) and MPCNL group(51.12±11.20 min)(P<0. 05);reduced Hb of MPCNL group(12.83±8.20 g/L) was higher than that of URSL(4.95±2.65 g/L) and RPLU groups(5.50±3.17 g/L) (P<0.05);postoperative hospitalization time of URSL(2.80±0.68d ) group was shorter than that of MPCNL(5.50±1. 38 d) and RPLU groups(5.50±3.17 g/L) (P<0.05);the residue rates of calculus of URSL group was higher than that of MPCNL and RPLU groups(P<0.05).Incidence rates of complications in three groups was not significant difference. Conclusion All of URL,MPCNL and RPLU have satisfying curative effects and safety guarantee in the treatment of upper ureteral calcu￣lus.But,consideration of general effecacy,MPCNL and RPLU are recommended.