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目的比较4种微创方式处理复杂性输尿管上段结石的疗效,探讨治疗复杂性输尿管上段结石的合理选择。方法回顾性分析武汉大学人民医院2008年2月—2011年1月403例复杂性输尿管上段结石患者的临床资料,依据体外冲击波碎石术(ESWL)、经尿道输尿管镜碎石术(URL)、微创经皮肾镜取石术(MPCNL)及后腹腔镜输尿管切开取石术(RLU)进行分组,比较患者临床资料及各组间的手术成功率、结石清除率、并发症发生率、住院时间及治疗费用。结果 403例患者中,ESWL治疗78例,URL 136例,MPCNL 103例,RLU 86例;一次治疗成功率ESWL组为41.0%,URL组为71.3%,MPCNL组为87.4%,RLU组为97.7%;术后1个月结石清除率ESWL组为69.2%,URL组为85.3%,MPCNL组为96.1%,RLU组为100.0%;住院时间ESWL组为(4.5±1.9)d,URL组为(6.5±2.1)d,MPCNL组为(9.6±1.9)d,RLU组为(9.1±2.2)d;治疗费用ESWL组为(3 947±721)元,URL组为(7 682±937)元,MPCNL组为(12 613±1 342)元,RLU组为(13 284±1 830)元;严重并发症发生率ESWL组为零,URL组为1.5%,MPCNL组为1.0%,RLU组为零。结论 4种方法均可用于治疗复杂性输尿管上段结石,ESWL和URL治疗时间短,损伤小,MPCNL和RLU治疗时间长,结石清除率及治疗费用均较高,应根据患者的临床情况和实际要求制定相应的治疗方案。
Objective To compare the curative effects of 4 minimally invasive approaches to complicated upper ureteral calculi and to explore a reasonable choice for the treatment of complex upper ureteral calculi. Methods The clinical data of 403 patients with complicated upper ureteral calculi in Wuhan University Hospital from February 2008 to January 2011 were retrospectively analyzed. According to the results of extracorporeal shock wave lithotripsy (ESWL), transurethral ureteroscopic lithotripsy (URL) The minimally invasive percutaneous nephrolithotomy (MPCNL) and retroperitoneal laparoscopic ureteral lithotomy (RLU) were divided into groups. The clinical data and operative success rates, stone clearance rates, complications, hospital stay And treatment costs. Results Among the 403 patients, ESWL treatment was performed in 78 cases, URL 136, MPCNL 103 and RLU 86. The success rate of primary treatment was 41.0% in ESWL group, 71.3% in URL group, 87.4% in MPCNL group and 97.7% in RLU group ; Stone clearance rate was 69.2% in ESWL group, 85.3% in URL group, 96.1% in MPCNL group and 100.0% in RLU group, (4.5 ± 1.9) days in ESWL group and 6.5 in URL group ± 2.1) d, (9.6 ± 1.9) d in MPCNL group and (9.1 ± 2.2) d in RLU group. The treatment cost was (3947 ± 721) in ESWL group and (7 682 ± 937) in URL group. (12 613 ± 1 342) yuan in RLU group and (13 284 ± 1 830) yuan in RLU group. The incidence of serious complication was zero in ESWL group, 1.5% in URL group, 1.0% in MPCNL group and zero in RLU group. Conclusion All the four methods are available for the treatment of complex upper ureteral calculi. ESWL and URL treatment time is short, injury is small, MPCNL and RLU treatment time is long, stone removal rate and treatment costs are high, according to the clinical situation and actual requirements Make the appropriate treatment plan.