肖峰,周传贵,徐宗华,穆毅,石家齐,陈方敏
XIAO Feng,ZHOU Chuangui,XU Zhonghua,MU Yi,SHI Jiaqi,CHEN Fangmin

• 1:贵航贵阳医院
• 2:贵州医科大学附院泌尿外科

摘要(Abstract)：

目的:比较输尿管上段嵌顿性结石3种微创手术方式优缺点。方法:选择467例输尿管上段嵌顿性结石患者随机分为输尿管镜碎石(URL)组、微通道经皮肾穿刺碎石术(MPCNL)组以及后腹腔镜下输尿管切开取石术(RLU)组,比较3组手术时间、出血量、结石清除率、住院时间及并发症发生率。结果:URL组、MPCNL组及RLU组结石一次性清除率分别为80.2%、98.1%及100%,MPCNL组与RLU组结石清除率高于URL组(P<0.05);URL组与MPCNL组比较手术时间较短、出血量少、住院时间短(P<0.01),并发症差异无统计学意义(P>0.05);URL组与RLU组比较手术时间短、并发症发生率高(P<0.01),住院时间、出血量差异无统计学意义(P>0.05)。结论:MPCNL是输尿管上段嵌顿性结石主要手术方式,URL对于该类结石清石率较低,应注意选择,RLU对于该类结石处理可达到与传统开放手术相似的效果,并可作为URL失败的补救。
Objective: To investigate efficacy of three kinds of minimally invasive surgery for upper ureteral incarcerated calculus. Methods: A total of 467 cases with upper ureteral incarcerated calculus were divided into ureteroscopic lithotripsy( URL) group,minimally invasive percutaneous nephrolithotomy( MPCNL) group,and retroperitoneal laparoscopic ureterolithotomy( RLU) group. Comparison were made concerning operation time,blood loss,stone clearance rate,length of hospital stay,and complications. Results: The rate of one-time clearance of URL was 80. 2%,98. 1% and 100% respectively,clearance rate of MPCNL group and RLU group were higher than that of URL group( P <0. 05). URL group showed shorter operation time,less blood loss,and shorter hospitalization time than MPCNL group( P < 0. 01),there was no statistically significant difference of complications( P >0. 05); URL group showed shorter operation time,high incidence of complications than RLU group( P< 0. 01),there was no statistically significant difference in hospital time and blood loss( P > 0. 05).Conclusions: MPCNL is the main operation way of upper ureteral incarcerated calculus; URL shows lower clearance rate. RLU can achieve the same result as the traditional open surgery,and it can serve as a remedy for the fails of URL.

关键词(KeyWords)： 输尿管结石;碎石术,激光;经皮肾镜取石术;输尿管镜下碎石术;后腹腔镜下输尿管上段切开取石术
ureteral calculi;lithotripsy,laser;minipercutaneous nephrolithotomy;ureteroscopic lithotripsy;retroperitoneal laparoscopic ureterolithotomy.

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 肖峰,周传贵,徐宗华,穆毅,石家齐,陈方敏
XIAO Feng,ZHOU Chuangui,XU Zhonghua,MU Yi,SHI Jiaqi,CHEN Fangmin

DOI: 10.19367/j.cnki.1000-2707.2015.09.025

参考文献(References)：

• [1]Nagele U,Schilling D,Anastasiadis AG,et al.Minimally invasive percutaneous nephrolitholapaxy(MIP)[J].Urologe A,2008(9):1066,1068-1073.
• [2]Hanson K.Minimallyinvasive and surgical management of urinary stones[J].Urol Nurs,2005(6):458-465.
• [3]武立新,王贺彬,吴刚,等.经皮肾镜治疗体外震波碎石失败的上尿路结石的临床研究[J].中华腔镜泌尿外科杂志,2013(6):22-25.
• [4]张正彪,马阳日,张洁祥,等.输尿管镜下钬激光碎石治疗体外震波碎石失败后复杂性输尿管结石[J].中华腔镜泌尿外科杂志,2013(6):29-31.
• [5]陈剑珩,申吉泓,刘孝东,等.后腹腔镜输尿管切开取石术治疗输尿管上段嵌顿结石(附43例报告)[J].国际泌尿系统杂,2013(1):20-22.
• [6]Karami H,Javanmard B,Hasanzadeh-Hedah A,et al.Is it necessary to place a double j catheter after laparoscopic ureterolithotomy?A four-year experience[J].J Endourol,2012(9):1183-1186.
• [7]Fang YQ,Qiu JG,Wang DJ,et al.Comparative study on ureteroscopic lithotripsy and laparescopic ureterolithotomy for treatment of unilateral upper ureteral stones[J].Acta Cir Bras,2012(3):266-270.
• [8]Nuttall MC,Abbaraju J,Dickinson IK,et al.A review of studies reporting on complications of upper urinary tract stone ablation using the holmium:YAG laser[J].Brit J MED Surg UROL,2010(4):151-159.
• [9]姚建忠,刘齐贵,窦坤,等.钬激光输尿管软硬镜结合治疗结石梗阻性急性肾功能衰竭39例分析[J].现代泌尿外科杂志,2012(3):278-280.
• [10]Xiao JG,Jian LL,Yan X,et al.Treatment of large impacted proximal ureteral stones:randomized comparison of minimally invasive percutaneous antegrade ureterolithotripsy versus retrograde uretemhthotripsy[J].World J Urol,2013(5):102-106.
• [11]李炯明,刘建和,陈戬,等.微通道经皮肾镜取石术治疗上尿路结石的疗效及安全性评价(附4533例报告)[J].临床泌尿外科杂志,2011(3):174-176.
• [12]Sun X,Xia S,Lu J,et al.Treatment of large impacted proximal urteral stones:randomized comparison of percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy[J].J Endourol,2008(5):913-915.
• [13]廖凯.输尿管上段结石不同治疗方法的疗效比较[J].当代医学,2011(32):69-71.
• [14]田生平,许汉标,杨伟忠,等.后腹腔镜输尿管切开取石术治疗困难的输尿管中上段结石[J].中国微创外科杂志,2011(8):715-717.
• [15]张旭.泌尿外科腹腔镜手术学[M].北京:人民卫生出版社,2008:105-109.

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