后腹腔镜、经皮肾镜和输尿管镜手术治疗嵌顿性输尿管上段结石的疗效比较

陈书尚; 朱凌峰; 杨顺良; 吴卫真; 谭建明

后腹腔镜、经皮肾镜和输尿管镜手术治疗嵌顿性输尿管上段结石的疗效比较

- 厦门大学附属南京军区福州总医院泌尿外科(福州, 350015)

详细信息

通讯作者: 谭建明,E-mail:doctortjm@yahoo.com

中图分类号: R572

收稿日期: 2011-10-09

Comparison of retroperitoneoscopic ureterolithotomy percutaneous nephrolithotomy and ureteroscopic lithotripsy for the treatment of impacted upper ureteral calculi

- Department of Urology, Fuzhou General Hospital, Xiamen University, Fuzhou, 350015, China

More Information

Corresponding author: TAN Jianming, E-mail: doctortjm@yahoo.com

Received Date: 09 October 2011

摘要

摘要: 目的:比较后腹腔镜输尿管切开取石术(RLU)、经肾镜取石术(mPCNL)、经输尿管镜取石术(URL)三种微创方法治疗嵌顿性输尿管上段结的临床疗效及安全性,探讨治疗嵌顿性输尿管上段结石的最佳手术方式。方法:229例嵌顿性输尿管上段结石患者229例患者随机分为3组,分别采用RLU(77例)、mPCNL(76例)和URL治疗(76例)。比较3组的治疗效果和并发症发生率。结果:RLU组和mPCNL组的手术成功率和结石取净率均明显高于URL组,分别为100% vs 100% vs 88.16%、100% vs 98.68% vs 82.09%(P <0.01)。RUL组的手术时间、住院时间均明显低于RLU组和mPCNL组,分别为(41.72±15.6)min vs(90.12±19.0)min vs (88.82±19.1)min、(3.70±1.9)d vs (8.65±1.6)d vs(8.76±2.1)d,P <0.01。mPCNL组的手术并发症发生率高于RLU组和URL组。结论:RLU、mPCNL及URL均可用于治疗嵌顿性输尿管上段结石,用何种方法应根据结石的位置、大小、存留时间及肾积水情况,遵循相对安全、有效、创伤小和经济实用的原则,并结合患者的个体差异,制定最佳方案。
- 腹腔镜术 /
- 经皮肾镜取石术 /
- 输尿管镜 /
- 输尿管结石
Abstract: Objective:To compare the efficacy of retroperitoneoscopic ureterolithotomy (RLU),minimally invasive percutaneous nephrolithotomy (mPCNL)and ureteroscopic lithotripsy (URL)for the treatment of impacted upper ureteral calculi,so as to explore the optimal treatment for impacted upper ureteral calculi.Method:A total of 229 cases of impacted upper ureteral calculi were randomized into 3 groups,receiving RLU (n=77),mPCNL (n=76)and URL (n=76),respectively.The therapeutic effect and the complication in the three groups were compared.Result:The success rate and stone free rate in Group RLU and Group mPCNL were significantly higher than Group URL (100% vs 100% vs 88.16%,100% vs 98.68% vs 82.09% respectively;P both <0.01),while the operation time and the length of stay in Group URL were significantly shorter than Group RLU and Group mPCNL (41.72±15.6) min vs (90.12±19.0) min vs (88.82±19.1) min,(3.70±1.9) d vs (8.65±1.6) d vs (8.76±2.1) d,P<0.01.Group mPCNL had higher complications.Conclusion:RLU,mPCNL and URL are applicable for the treatment of impacted upper ureteral calculi.An optimal therapeutic method should be determined according to the practical situation,including position and size of the stone,hydronephrosis,and other individual characters,following the principle of safety,utility,minimal invasiveness and economy.
- retroperitoneoscope /
- percutaneous nephrolithotomy /
- ureteroscope /
- ureteral calculi

HTML全文

参考文献(8)

[1]	江波涛,刘修恒,匡幼林,等.不同微创方法治疗复杂性输尿管上段结石的比较[J].中华腔镜泌尿外科杂志(电子版),2009,3(1):34-36.
[2]	毛峥,商庆兵,王婵等.三种腔镜技术治疗复杂性输尿管上段结石的疗效比较[J].临床泌尿外科杂志,2010,25(8):595-598.
[3]	张旭,朱庆国,马鑫,等.后腹腔镜输尿管切开取石术26例[J].临床泌尿外科杂志,2003,18(6):327-329.
[4]	HEMAL A K,GOEL A,GOEL R.Minimally invasiveretroperitoneoscopic ureterolithotomy[J].J Urol,2003,169:480-482.
[5]	李海平,杨艳颖,韩子华,等.后腹腔镜输尿管切开取石术与经尿道输尿管镜碎石术治疗输尿管上段结石的疗效比较[J].中国基层医药,2010,17(13):1826-1827.
[6]	陆佳荪,温机灵,温晓飞,等.经输尿管镜治疗输尿管上段结石失败原因的分析及对策[J].中华腔镜泌尿外科杂志(电子版),2010,4(2):116-118.
[7]	高小峰,陈书尚,孙颖浩,等.钬激光输尿管镜下碎石与经皮肾取石治疗嵌顿性输尿管上段结石的比较[J].中国微创外科杂志,2007:7(10)944-947.
[8]	李逊,曾国华,袁坚,等.经皮肾穿刺取石术治疗上尿路结石(20年经验)[J].北京大学学报(医学版),2004,36:124-126.