三种微创手术治疗复杂性输尿管上段结石的临床疗效及安全性比较欧.DOC

三种微创手术治疗复杂性输尿管上段结石的临床疗效及安全性比较 欧 平，邓晓洪，郑 军，王元中，陈高亮 [摘要目的比较经尿道输尿管镜碎石术、微创经皮肾穿刺取石术及后腹腔镜输尿管切开取石术三种微创手术方式治疗复杂性输尿管上段结石的有效性及安全性方法回顾性分析我收治的复杂性输尿管上段结石患者82例。21例行经尿道输尿管镜碎石术（Trans-urethral Ureteroscope Lithotripsy，URL），28例患者行微创经皮肾穿刺取石术（Minimally Invasive Percutaneous Nephrol ithotomy，MPCNL）、33例患者行后腹腔镜输尿管切开取石术（Retroperitoneoscopic Ureterolithotomy，RLU），对比分析组患者手术时间、术中出血量、术后住院时间、住院费用、结石清除率及并发症结果组患者之间年龄、性别、体重指数、结石大小等方面比较无显著差异。URL组、MPCNL组、RLU组手术成功率分别为66.7%，100%，100%术后一月结石清除率分别为为85.0%，，100％。URL组、MPCNL组、 RLU组术后并发症发生率为14.2％，21.4%，0％。术后随访时间6至27月，无复发结论URL对患者损伤小，但一次清除率低。MPCNL结石清除率高，但手术风险较大，而RLU具有创伤小、出血少、并发症少、一次性取石成功率高等优点，通常不需联合其他治疗手段，是复杂性输尿管上段结石比较理想的治疗方法。关键词输尿管上段复杂结石；输尿管镜碎石术；经皮肾穿刺取石术；后腹腔镜输尿管切开取石术 omplex Upper Ureteral Calculi OU Ping1 ，DENG Xiao-hong ，ZHENG Jun ，WANG Yuan-zhong ，CHENG Gao-liang .（Department of Urology ，the Zhongshan Hospital, Chongqing, 400013 , China） [Abstract] Objective To evaluate?clinical?value and safty?of three different minimally invasive surgery in the treatment of complex upper ureteral calculi. Methods We retrospectively analyzed data from 82 patients with complex upper ureteral stones at our institutions from March 2009 to Augest 2013. Twenty-one patients underwent trans-urethral ureteroscope lithotripsy(group URL), 28 patients underwent minimally invasive percutaneous nephrol ithotomy(group MPCNL), and 33 patients underwent retroperitoneoscopic ureterolithotomy， (group RLU) for removal of upper ureteral stones. retrospectively analyzed and compared each method’s rate of success and complications． ResultsThere were no significant differences in age, sex, or stone size among the three groups. Success rates in the URL, MPCNL and RLU groups were 66.7%, 100%, and 100%, respectively, the stone clearance rate one month after operation was 85.0%, 96.4% , and 100%, respectively, the incidence of complication in the URL, MPCNL and RLU groups were 14.2%, 21.4%, and 0%, respectively. During the period followed 6-27 months， recurrent calculus had not been found.Concl