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目的:比较微创经皮肾镜取石术(minimally invasive percutaneous nephrolithotomy,MPCNL)与后腹腔镜输尿管切开取石术(retroperitoneal laparoscopic ureterolithotomy,RLUL)治疗嵌顿性输尿管上段结石的有效性及安全性。方法:分析2006年6月～2012年4月我院收治的嵌顿性输尿管上段结石患者208例,年龄21～76岁,平均45.3岁。根据治疗方法分为两组,MPCNL治疗(MPCNL组)158例,RLUL治疗(RLUL组)50例,比较2组手术时间、术中出血量、术后住院时间、住院费用、结石清除率及手术并发症。结果:所有患者均耐受手术,无严重并发症发生。RLUL组手术时间为(88.6±21.9)min,显著长于MPCNL组的(64.2±18.6)min(t=-7.683,P=0.000)。术后1个月的结石清除率MPCNL组为98.7%(156/158),RLUL组为100.0%(49/49),差异无统计学意义(χ2=0.002,P=0.965)。术后并发症发生率两组差异无统计学意义(χ2=3.051,P=0.081)。术中出血量MPCNL组为(62.4±10.6)ml,显著高于RLUL组的(38.7±9.3)ml(t=14.058,P=0.000)。术后住院时间MPCNL组为(6.3±1.4)d,长于RLUL组(4.1±1.2)d(t=9.923,P=0.000)。住院费用MPCNL组为(11 562.4±1 228.5)元,高于RLUL组(9 546.6±1 082.6)元(t=10.308,P=0.000)。术后随访6～24个月,平均12个月,未见输尿管狭窄和输尿管结石复发。结论:MPCNL与RLUL在治疗嵌顿性输尿管上段结石上都具有满意的疗效与安全性,RLUL术中出血较少,但手术时间长,在有条件且技术成熟的医院可适当开展。
Objective: To compare the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MPCNL) and retroperitoneal laparoscopic ureterolithotomy (RLUL) in the treatment of upper ureteral calculi. Methods: From June 2006 to April 2012, 208 cases of incarcerated ureteral calculi in our hospital were treated, ranging in age from 21 to 76 years with an average of 45.3 years. According to the treatment methods, the patients were divided into two groups: MPCNL group (158 cases) and RLUL group (50 cases). The operation time, intraoperative blood loss, postoperative hospital stay, hospitalization, stone clearance rate and operation complication. Results: All patients were tolerant of surgery without serious complications. The operative time in RLUL group was (88.6 ± 21.9) min, significantly longer than that in MPCNL group (64.2 ± 18.6) min (t = -7.683, P = 0.000). The stone clearance at 1 month after operation was 98.7% (156/158) in MPCNL group and 100.0% (49/49) in RLUL group, with no significant difference (χ2 = 0.002, P = 0.965). The incidence of postoperative complications was no significant difference between the two groups (χ2 = 3.051, P = 0.081). The amount of bleeding in MPCNL group was (62.4 ± 10.6) ml, significantly higher than that in RLUL group (38.7 ± 9.3) ml (t = 14.058, P = 0.000). The postoperative hospital stay was (6.3 ± 1.4) d in MPCNL group, which was longer than that in RLUL group (4.1 ± 1.2) d (t = 9.923, P = 0.000). The hospitalization cost was (11 562.4 ± 1 228.5) yuan in MPCNL group, which was higher than that in RLUL group (9 546.6 ± 1.082.6 yuan) (t = 10.308, P = 0.000). Follow-up 6 to 24 months after surgery, an average of 12 months, no ureteral stricture and ureteral stones recurrence. CONCLUSION: Both MPCNL and RLUL have satisfactory curative effect and safety in the treatment of incarcerated upper ureteral calculi. RLUL has less bleeding, but the operation time is longer, which can be properly carried out in the qualified and mature hospitals.