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目的:比较经尿道输尿管镜取石术(URL)、微创经皮肾镜取石(MPCNL)、后腹腔镜输尿管切开取石术(RLU)治疗复杂性输尿管上段结石的疗效。方法:113例复杂性输尿管上段结石患者按治疗方法分为三组:URL组46例,MPCNL组38例,RLU组29例。结果:URL组一周结石清除率21.74%(10/46),无严重并发症发生,平均住院6天。MPCNL组1周结石清除率92.10%(35/38),术后发热10.52%,6例因术中出血,改为二期取石,手术成功;8例术中冲洗液外渗,1例大出血行保守治疗好转,平均住院9天。RLU组有1例转开放取石,一周结石清除率100%,无严重并发症出现,平均住院6.5天。RLU组的一周结石清除率显著高于URL及MPCNL组,术后并发症发生率明显低于MPCNL。结论:RLU治疗复杂性输尿管上段结石具有结石清除率高、术后并发症少、恢复快的优点。MPCNL、URL和RLU三种方法均可用于治疗复杂性输尿管上段结石,使用何种方法应视临床具体情况而定。
Objective: To compare the efficacy of transurethral ureteroscopic lithotripsy (URL), minimally invasive percutaneous nephrolithotomy (MPCNL) and retroperitoneal laparoscopic ureteral calculi (RLU) in the treatment of complex upper ureteral calculi. Methods: A total of 113 patients with complicated upper ureteral calculi were divided into three groups according to the treatment method: 46 cases in URL group, 38 cases in MPCNL group and 29 cases in RLU group. Results: The clearance rate of stone in one week was 21.74% (10/46) in the URL group. There was no serious complication and the average hospital stay was 6 days. One week after operation, the rate of stone removal in the MPCNL group was 92.10% (35/38) and the postoperative fever was 10.52%. Six cases were replaced by two stages of stone bleeding due to intraoperative bleeding, and the operation was successful. Eight cases of extravasation of irrigating fluid and one case of hemorrhage Conservative treatment improved, the average hospital 9 days. In the RLU group, 1 patient turned to open stone and the rate of stone removal in one week was 100%. No serious complications occurred, and the average hospital stay was 6.5 days. The stone clearance rate in one week in RLU group was significantly higher than that in URL and MPCNL group, and the incidence of postoperative complications was significantly lower than that in MPCNL. Conclusion: RLU has the advantages of high stone clearance, less postoperative complications and quick recovery in the treatment of complex upper ureteral calculi. MPCNL, URL and RLU three methods can be used to treat complex upper ureteral calculi, the use of which method should be determined according to clinical specific circumstances.