输尿管软镜、微创经皮肾镜、后腹腔镜治疗输尿管上段结石比较探讨.docVIP

输尿管软镜、微创经皮肾镜、后腹腔镜治疗输尿管上段结石的比较研究 　　[摘要] 目的 为了提高保守治疗和体外冲击波碎石治疗失败的输尿管上段结石的治疗效果，并寻求最佳的治疗方法，研究和探讨输尿管软镜（RIRS）、微创经皮肾镜取石术（MPCNL）、后腹腔镜输尿管切开取石术（RLU）3种微创手术方法治疗输尿管上段结石的优劣。 方法 回顾性分析整群选取的188例于2014年1月―2016年1月来该院手术治疗的输尿管上段结石患者，根据手术治疗方法不同分为 3组，分别是输尿管软镜组、微创经皮肾镜组、后腹腔镜组，探讨和研究3种不同的治疗方案疗效和安全性差异。 结果 经过研究发现，虽然RIRS组和MPCNL组、 RLU组相比术后3～5 d结石清除率较低，且两组比较差异有统计学意义（P0.05）；RIRS组的失血量、住院时间和MPCNL组相比显著降低，且两组患者比较差异有统计学意义（P0.05）。 结论 输尿管上段结石的治疗方案要根据患者结石和全身情况综合考虑。输尿管软镜治疗输尿管上段结石的清石清除率较低，必须根据患者的具体病情况和综合条件进行选择，但输尿管软镜具有损伤小、步骤简单、易同时处理双侧结石、住院时间短等优点，逐渐成为输尿管结石的首选手术治疗方案。微创经皮肾镜目前仍可作为输尿管上段结石治疗的常用方案， RLU的清石效果和传统开放手术大致相同，值得应用 [关键词] 输尿管上段结石；输尿管软镜；微创经皮肾镜取石术；后腹腔镜输尿管切开取石术；疗效 [中图分类号] R693 [文献标识码] A [文章编号] 1674-0742（2016）06（a）-0001-04 [Abstract] Objective To improve the therapeutic effect of upper ureteral calculi which failed in conservative therapy and extracorporeal shock wave lithotripsy treatment and seek the best treatment method， study and explore the pros and cons of retrograde intrarenal surgery（RIRS）， minimally ivasive percutaneous nephrolithotomy（MPCNL）， retroperitoneal laparoscopic ureterolithotomy （RLU） three kinds of minimally invasive surgical method of the upper ureteral calculi. Methods Group selection retrospective analysis of 188 cases of upper ureteral calculi patients surgically treated in our hospital from January 2014 to 2016 January which were divided into 3 groups according to different surgical treatment， respectively is RIRS group（n=51）， MPCNL group（n=73） and RLU group（n=64）， to explore and study the efficacy and safety of three different treatments. Results It was found from the study that compared with MPCNL group and RLU group， the stone clearance rate of 3～5 days after operation was lower in RIRS group and there was a significant difference （P 0.05） of the stone clearance rate of 3 months after operation and surgical complications in three groups. Conclusion The treatment of upper ureteral calculi should be considered in accordance with the stones and the general situation of the patie