后腹腔镜与经皮肾镜治疗复杂性输尿管上段结石疗效比较

摘要

Objective To compare the safety and effects of retroperitoneal laparoscopic ureterolithotomy(RLU)and microinva-sive percutaneous nephrolithotomy with lithotomy (MPCNL)for treating complicated upper ureteral calculi and to explore the sur-gical indications and the technical key points.Methods The clinical data in 54 cases of complicated upper ureteral calculi from Mar. 2009 to Sep.2012 were retrospectively analyzed,31 cases adopted the MPCNL therapy (MPCNL group)and 23 cases received the RLU therapy(RLU group).The perioperative complications and the stone clearance rate were compared between the two groups. Results The mean operating time was (69.70±7.73)min in the RLU group and (46.50±7.09)min in the MPCNL group(t=-11.436,P=0.000);the intraoperative blood loss was (21.50±7.23)mL in the RLU group and (66.90±20.00)mL in the MPC-NL group(t=9.94,P=0.000),the MPCNL group was significantly higher than the RLU group;no statistically significant differ-ences were found in the occurrence rate of postoperative hyperpyrexia,the stone clearance rate,the occurrence rate of urinary leak-age and the length of hospital stay between the two groups.Conclusion Both MPCNL and RLU have high safety and satisfactory effects for treating complicated upper ureteral calculi.RLU has less intraoperative blood loss and long operation time.%目的：比较后腹腔镜输尿管切开取石术（RLU）与微创经皮肾镜取石术（MPCNL）治疗复杂性输尿管上段结石的安全性及疗效，探讨两种术式的适应证及技术要点。方法回顾性分析2009年3月至2012年9月54例复杂性输尿管上段结石患者的临床资料，31例采用 MPCNL治疗（MPCNL组），23例采用 RLU治疗（RLU组），比较两组患者的手术并发症和结石清除率。结果 RLU组与 MPCNL组的手术时间分别为（69．70±7．73）min vs．（46．50±7．09）min（t＝-11．436，P＝0．000）；术中出血量为（21．50±7．23）mL vs．（66．90±20．00）mL，MPCNL组显著高于RLU组（t＝9．94，P＝0．000）；术后3 d的结石清除率、术后高热发生率、术后尿漏发生率、住院时间等两组比较差异无统计学意义（P＞0．05）。结论 MPCNL与 RLU治疗复杂性输尿管上段结石都具有较高的安全性与疗效，RLU术中出血较少，但手术时间长。