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目的:比较开放性输尿管切开取石术(UL)、腹腔镜输尿管切开取石术(RLU)及逆行输尿管镜碎石术(URL)治疗嵌顿性输尿管结石(IUS)的疗效。方法:回顾分析150例嵌顿性输尿管结石患者的临床资料,其中男82例,女68例。根据手术方式随机将患者分为UL组和RLU组以及URL组,分别比较两组之间一次手术成功率、手术时间、术中出血量、术中出现输尿管穿孔,撕脱,大出血、术后住院时间、术后双J管拔出时间、结石清除率、及术后出现输尿管狭窄发生率。结果:三组患者在年龄、结石长径、梗阻位置、梗阻时间上无统计学意义,UL组和RLU组在一次手术成功率、手术时间、术中出血量、术中出现穿孔、撕脱、大出血、双J管拔除时间、结石清除率及术后输尿管狭窄发生率上差异无统计学意义(P>0.05),而在术后住院时间上,RLU组要明显优于UL组(P<0.05)。URL组与UL组及RLU组在手术时间、术中出血量、术后双J管拔除时间上差异无统计学意义;而在术中出现输尿管穿孔、撕脱、大出血、术后出现输尿管狭窄上,URL组发生率要明显高于其他两组(P<0.05)。一次治疗成功率:UL 100%,RLU 95.5%,URL 87.2%。术后2个月结石清除率:UL 100%,RLU100%,URL 74.5%。结论:在嵌顿性输尿管结石治疗方面,URL组与RLU组及UL组在手术时间、术中出血量、术后住院时间、术后双J管拔除时间差异无统计学意义,而术中出现并发症及术后输尿管狭窄发生率上URL组明显高于RLU组与UL组。RLU组较UL组在手术时间、术中术后并发症方面差异无统计学意义,但具有手术创伤小、术后恢复快的优点,有条件的医院可优先考虑采取RLU。
Objective: To compare the curative effect of open ureterolithotomy (UL), laparoscopic ureteral lithotomy (RLU) and retrograde ureteroscopic lithotripsy (URL) in the treatment of incarcerated ureteral calculi (IUS). Methods: A retrospective analysis of 150 cases of incarcerated ureteral calculi in patients with clinical data, including 82 males and 68 females. The patients were randomly divided into UL group, RLU group and URL group according to the operation method. The success rate of operation, operation time, blood loss during operation, ureter perforation, avulsion, bleeding and postoperative hospital stay Time, double J tube after the pull-out time, stone clearance rate, and the incidence of postoperative ureteral stenosis. Results: There was no significant difference in the age, the length of the stone, the position of the obstruction and the time of obstruction in the three groups. The success rate of operation, the operation time and the amount of intraoperative blood loss in UL group and RLU group were as follows: perforation, avulsion, There was no significant difference in bleeding, double J tube removal time, stone clearance rate and the incidence of postoperative ureteral stricture (P> 0.05), while in the postoperative length of stay, the RLU group was significantly better than the UL group (P <0.05 ). There was no significant difference between URL group and UL group and RLU group in the operation time, intraoperative blood loss and postoperative double-J tube removal time, while ureteral perforation, avulsion and hemorrhage occurred during surgery, and ureteral stricture , The incidence of URL group was significantly higher than the other two groups (P <0.05). One treatment success rate: UL 100%, RLU 95.5%, URL 87.2%. Stone clearance rate 2 months after surgery: UL 100%, RLU 100%, URL 74.5%. Conclusions: There is no significant difference between the URL group and the RLU group and the UL group in the operation time, intraoperative blood loss, postoperative hospital stay, postoperative double J tube removal time in the treatment of incarcerated ureteral calculi Complications and the incidence of postoperative ureteral stenosis in the URL group was significantly higher than the RLU group and the UL group. There was no significant difference between the RLU group and the UL group in terms of operation time and postoperative complications. However, RLU group had the advantages of small operation trauma and rapid postoperative recovery. The qualified hospitals could give priority to RLU.