Objective: To explore the clinical effects of retroperitoneal laparoscopic ureterolithotomy (RPLU) and flexible-ureteroscopic holmium laser lithotripsy (f-UHLL) for complicated upper ureteral calculi. Methods: A total of 45 cases of complicated upper ureteral calculi between March 2014 and January 2016 in Department of Urology, Affiliated Jiangyin Hospital of Southeast University Medical College were retrospectively analyzed, there were 32 males and 13 females, ranging from 27 to 45 years with an average age of (34.1±9.5) years. Of the 45 patients, 28 had ureteral distortion and 17 had concurrent ureteral stones in the lower or middle ipsilateral ureter. In those patients, 20 cases underwent f-UHLL, and 25 cases received RPLU. The stone size, operation time, hospital stay, stone clearance rates and postoperative fever rates between the two groups were compared with t test and χ(2)test. Results: The operation was successfully performed in all patients, no complications with leakage of urine or ureteral perforation occurred, and no significant difference in renal function between the two methods were founded in postoperative period. There was no significant difference in operation time((78.4±8.5) minuetes vs.(73.3±11.3) minuetes, t=0.61, P=0.67), time of double J tube removed ((33.8±3.4)days vs. (37.6±8.9) d, t=2.37, P=0.08) and ipsilateral renal glomerular filtration rates ((41.3±7.6)ml/minuetes vs.(40.5±7.1) ml/min, t=0.78, P=1.27) between the two groups. However, the hospitalization time ((5.9±1.7)days vs. (4.2±1.6) days, t=1.92, P=0.04), postoperative fever rates (4% vs.30%, χ(2)=5.72, P=0.03) and calculus clearance rates (100% vs. 75%, χ(2)=7.03, P=0.01) in RPLU were significantly higher than f-UHLL. Besides, 5 patients in the f-UHLL group had postoperative stone residue and were treated with extracorpore shock wave lithotripsy. Conclusions: Both RPLU and f-UHLL are safety and validity for complex upper ureteral calculi. RPLU can improve the rate of calculus removal and reduce the rate of postoperative fever.
目的： 比较后腹腔镜下输尿管切开取石术(RPLU)与输尿管软镜钬激光碎石术(f－UHLL)治疗复杂性上段输尿管结石的效果。 方法： 回顾性分析东南大学医学院附属江阴医院泌尿外科2014年5月至2016年1月收治的45例复杂性上段输尿管结石患者的病例资料，其中男性32例，女性13例，年龄27～45岁，平均(34.1±9.5)岁。合并输尿管扭曲28例，合并同侧输尿管中下段结石17例。20例接受f－UHLL治疗，25例接受RPLU治疗。记录两组患者的结石大小、手术时间、术后住院时间、结石清除率和术后发热率等。分别采用t检验和χ(2)检验对计量资料和计数资料进行统计学分析。 结果： 所有患者顺利完成手术，无漏尿、输尿管穿孔等并发症，手术未对肾功能产生明显影响。RPLU组和f－UHLL组患者在手术时间[(78.4±8.5)min比(73.3±11.3)min，t＝0.61，P＝0.67]、术后拔除双J管时间[(33.8±3.4)d比(37.6±8.9)d，t＝2.37，P＝0.08]、术后患肾肾小球滤过率[(41.3±7.6)ml/min比(40.5±7.1)ml/min，t＝0.78，P＝1.27]方面差异均无统计学意义；与f－UHLL组相比，RPLU组住院时间长[(5.9±1.7)d比(4.2±1.6)d，t＝1.92，P＝0.04]，术后发热率低(4%比30%，χ(2)＝5.72，P＝0.03)、结石清除率高(100%比75%，χ(2)＝7.03，P＝0.01)。f－UHLL组5例患者术后发生结石残留，予以体外冲击波碎石治疗后结石自行排出。 结论： RPLU与f－UHLL在治疗复杂性上段输尿管结石方面均安全、有效，RPLU相比f－UHLL可在提高结石清除率的同时降低术后的发热率。.
Keywords: Laparoscopy; Lithotripsy, laser; Ureteral calculi.