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目的:分析输尿管上段结石3种不同微创手术疗效。方法:对贵航贵阳医院收治的467例输尿管上段结石患者分别选用:输尿管镜碎石(ureteroscopic lithotripsy,URL)、微通道经皮肾穿刺碎石术(mini-percutaneous nephrolithotomy,MPCNL)以及后腹腔镜下输尿管切开取石术(retroperitoneal laparoscopic ureterolithotomy,RLU)。结果:154例行MPCNL,结石一次性清除率为98.1%;URL共142例,结石清除率为80.2%,26例结石进入肾盂未能碎石,2例改行MPCNL、RLU或开放手术;RLU共171例,结石一次性清除率为100%。结论:MPCNL可成为输尿管上段结石的主要手术方式;URL对于该类结石不宜作首选;RLU对于该类结石处理可达到与传统开放手术相近的效果,可作为URL失败的补救。
Objective: To analyze the curative effect of three kinds of minimally invasive surgery on upper ureteral calculi. Methods: A total of 467 patients with upper ureteral calculi treated with Guiyang Hospital were enrolled in this study: ureteroscopic lithotripsy (URL), mini-percutaneous nephrolithotomy (MPCNL) and retroperitoneal laparoscopy Retroperitoneal laparoscopic ureterolithotomy (RLU). Results: One hundred and fifty-four cases of MPCNL had a one-time clearance rate of 98.1%. There were 142 URLs with stone clearance rate of 80.2%, 26 cases of stones failed to enter the renal pelvis, 2 cases of MPCNL, RLU or open surgery, 171 cases, one-time stone clearance rate was 100%. CONCLUSION: MPCNL can be the main surgical method for upper ureteral calculi. URL should not be the first choice for this type of stones. RLU can be used as a remedy for URL failure because RLU can achieve the same effect as traditional open surgery.