腹腔镜输尿管切开取石与经皮肾镜碎石术治疗输尿管上段复杂结石的临床效果观察

郁全胜　陈猛　陈志永

[摘要]目的 比较腹腔镜输尿管切开取石（RLU）与经皮肾镜碎石术（PCNL）治疗输尿管上段复杂结石的臨床效果。方法 回顾性分析2012年1月～2015年12月在沭阳县人民医院吴阶平泌尿外科中心和东南大学医学院附属徐州医院泌尿外科手术治疗的67例输尿管上段复杂结石患者的临床资料，按照手术方式分为RLU组（31例）和PCNL组（36例），比较两组的手术时间、术中出血量、结石清除率、术后最高体温、尿管拔除时间、术后住院时间。结果 两组的手术时间、结石清除率、术后最高体温比较，差异无统计学意义（P>0.05）。RLU组的术后尿管拔除时间和术后住院时间短于PCNL组，术中出血量少于PCNL组，差异有统计学意义（P<0.01）。结论 RLU是一种安全的治疗方式，其治疗输尿管上段复杂结石可以缩短术后住院时间，且术中出血量较少。

[关键词]输尿管上段复杂结石；腹腔镜；经皮肾镜；手术并发症

[中图分类号] R691.4 [文献标识码] A [文章编号] 1674-4721（2017）03（b）-0031-04

[Abstract]Objective To compare the clinical effect of laparoscopic ureteroscopy and percutaneous nephrolithotomy in the treatment of complex upper ureteral calculi.Methods A clinical data of 67 patients with complex upper ureteral calculi from January 2012 to December 2015 in the WU Jie-ping Urology Center of People′s Hospital of Shuyang County and Department of Urology of Xuzhou Hospital Affiliated to Medical College of Southeast University were retrospectively analyzed.The patients were divided into the RLU group （n=31） and the PCNL group （n=36） according to the operation mode，and the operation time，intraoperative blood loss，stone clearance rate，maximum body temperature，time of catheter removal，and postoperative hospital stay were compared between the two groups.Results There was no significant difference between the two groups in the operation time，stone clearance rate and the maximum body temperature after operation （P>0.05）.The time of catheter removal，and postoperative hospital stay in the RLU group was shorter than that in the PCNL group，the amount of intraoperative blood loss in the RLU group was lower than that in the PCNL group，with significant difference （P<0.01）.Conclusion RLU is a safe treatment，and the treatment of upper ureteral calculi can shorten the length of hospital stay and reduce the amount of bleeding.

[Key words]Complex upper ureteral calculi；Laparoscope；Percutaneous nephroscope；Operative complication

输尿管结石在泌尿外科住院患者中占首位，其中，因结石位置较高、逆行输尿管镜进镜失败等原因导致的输尿管镜无法解决的输尿管结石占很大部分，笔者将其称之为输尿管上段复杂结石。目前对输尿管复杂结石的治疗方法常见的有腹腔镜输尿管切开取石（retroperitoneal laparoscopic ureterolithotomy，RLU）、经皮肾镜碎石术（percutaneousne phrolithotomy，PCNL）和输尿管切开取石等，输尿管结石的治疗趋向于腔镜、微创治疗，开放的输尿管切开取石成为补充的治疗术式，但是目前对RLU和PCNL两种术式的选择处于经验选择阶段，尚无定论。本研究通过回顾性研究，旨在比较RLU和PCNL两种不同手术方式治疗输尿管上段复杂结石的手术时间、术中出血量、结石清除率、术后最高体温、尿管拔除时间、术后住院时间等方面的差异。