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目的评估后腹腔镜输尿管切开取石术(RLU)与微创经皮输尿管镜钬激光碎石取石术(MPCUL)治疗直径>1 cm,结石≤3枚;3.5 cm<结石距肾盂输尿管连接处(UPJ)<6.5 cm的复杂性输尿管上段结石的疗效。方法 2010年1月至2012年12月间,于1573例来兰州军区兰州总医院门诊就诊的输尿管结石患者中,按纳入标准和排除标准选择206例复杂性输尿管上段结石患者,以前瞻性随机对照研究方法分为RLU及MPCUL治疗组,每组103例记录两组患者术前一般资料,两组患者首次手术时间、总治疗时间、结石一次性排出或取净率、并发症发生率、总治疗费用、效率商(EQ值)及患肾肾小球滤过率(GFR)恢复等方面进行统计学分析。结果两组术前一般资料无明显统计学差异。RLU组首次手术时间为(90±15)min,总治疗时间20.4 d,结石一次性排出或取净率97.1%,并发症发生率6.8%,总治疗费用(1.8±0.7)万元,EQ值93.5%,术后3、6、9、12个月患肾GFR(27.5±1.5)、(41.6±1.7)、(49.6±1.3)、(53.1±0.8)ml/min,而MPCUL组分别为(50±10)min,19.4 d,92.2%,13.6%,(2.5±0.6)万元,84.8%,(23.6±1.1)、(31.1±1.4)、(38.7±1.7)、(43.5±1.5)ml/min。两组疗效差异均有统计学意义(P<0.05)。结论对于复杂性输尿管上段结石,RLU治疗优于MPCUL。
Objective To evaluate the clinical value of retroperitoneal laparoscopic ureteral lithotomy (RLU) and minimally invasive percutaneous ureteroscopic holmium laser lithotripsy (MPCUL) in the treatment of patients with diameter> 1 cm and stones ≤ 3 pieces; 3.5 cm < UPJ) <6.5 cm complex upper ureteral calculi. Methods From January 2010 to December 2012, 206 patients with complicated ureteral calculi were enrolled in the 1573 cases of ureteral calculi who visited the Lanzhou General Hospital of Lanzhou Military Region in accordance with the inclusion criteria and exclusion criteria. A prospective randomized controlled study The research methods were divided into RLU and MPCUL treatment group, 103 cases in each group recorded the general information of two groups before operation, the first operation time, the total treatment time, the time of stone excretion or removal, the incidence of complications, the total treatment Cost, EQ and renal glomerular filtration rate (GFR) recovery and other aspects of statistical analysis. Results There was no statistically significant difference between the two groups before surgery. The time of the first operation in RLU group was (90 ± 15) min and the total treatment time was 20.4 days. The rate of one-off or removal of stones was 97.1%, the complication rate was 6.8% and the total treatment cost was 1.8 ± 0.7 million. The EQ value 93.5%, GFR was (27.5 ± 1.5), (41.6 ± 1.7), (49.6 ± 1.3) and (53.1 ± 0.8) ml / min respectively at 3, 6, 9 and 12 months after operation, (23.6 ± 1.1), (31.1 ± 1.4), (38.7 ± 1.7), (43.5 ± 1.5) ml / min. The difference between the two groups was statistically significant (P <0.05). Conclusions For complex upper ureteral calculi, RLU is superior to MPCUL.