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目的比较三种不同微创手术方法治疗嵌顿性输尿管上段结石的疗效。方法对广西中医学院第一附属医院120例嵌顿性输尿管上段结石患者的临床资料进行回顾性分析,其中后腹腔镜输尿管切开取石术(RPUL)组36例,输尿管镜下取石术(URL)34例,微创经皮肾镜取石术(MPCNL)50例。比较3组手术时间、术后出血量、结石清除率及并发症发生率。结果 RPUL组、URL组及MPCNL组结石清除率分别为91.7%、70.6%和96.0%,RPUL组及MPCNL组显著优于URL组(P<0.05);RPUL组、URL组及MPCNL组手术时间分别为(129.46±23.08)、(37.58±5.83)及(80.32±9.47)min,差别具有统计学意义(P<0.05);3组术后出血量分别为(30.31±4.28)、(26.36±3.71)及(82.36±6.21)ml,RPUL组及URL组显著少于MPCNL组(P<0.05);3组并发症发生率分别为8.3%、5.9%和8.0%,差别无统计学意义(P>0.05)。结论与URL相比,MPCNL及RPUL治疗嵌顿性输尿管上段结石清石率高,且安全有效。
Objective To compare the curative effects of three different minimally invasive surgeries in the treatment of upper ureteral calculi. Methods The clinical data of 120 cases of incarcerated upper ureteral calculi in the First Affiliated Hospital of Guangxi College of Traditional Chinese Medicine were retrospectively analyzed. Among them, 36 cases were treated with retroperitoneal laparoscopic ureterolithotomy (RPUL), ureteroscopic lithotripsy (URL) 34 cases, minimally invasive percutaneous nephrolithotomy (MPCNL) 50 cases. The operation time, postoperative blood loss, stone removal rate and complication rate were compared between the three groups. Results The stone clearance rates in RPUL group, URL group and MPCNL group were 91.7%, 70.6% and 96.0%, respectively, which were significantly higher in RPUL group and MPCNL group than those in URL group (P <0.05). The operation time of RPUL group, URL group and MPCNL group were (129.46 ± 23.08), (37.58 ± 5.83) and (80.32 ± 9.47) min, respectively, with statistical significance (P <0.05). The postoperative bleeding volume in the three groups were (30.31 ± 4.28) and (26.36 ± 3.71) And (82.36 ± 6.21) ml respectively in the RPUL group and the URL group were significantly lower than those in the MPCNL group (P <0.05). The complication rates in the three groups were 8.3%, 5.9% and 8.0% respectively, with no significant difference (P> 0.05 ). Conclusion Compared with the URL, MPCNL and RPUL treatment of incarcerated ureteral calculi of the upper clear rate, and safe and effective.