ABSTRACT
Objective To analyze the four types of laparoscopic operation in the treatment of upper ureteral calculi with diameter more than 1 cm.Methods From July 2012 to September 2015,150 cases of patients with upper ureteral calculi diameter more than 1cm were analyzed.According to the different surgical methods,patients were divided into four groups.There are 39 cases in URL group,32 cases in RLU group,36 cases in PCNL group and 43 cases in FURL group.The diameter of calculi in RLU group and PCNL group was much larger than those in URL group and FURL group(P ＜ 0.05).There was no difference in terms of sex,age,stone location,stone composition,and the ESWL treatment failure rate among the four groups(P ＞ 0.05).The operation time,postoperative hospitalization days,postoperative bowel recovery,postoperative ESWL rate,complications and postoperative calculi clearance rate were compared among the four groups.Results In RLU,PCNL,URL and FURL group,the operation time were (38.5 ± 13.0) min,(83.4 ± 6.1) min,(69.6 ± 13.0) min and (50.1 ± 6.3) min,respectively,and there were significant differences among the four groups (RLU group ＞ PCNL group ＞ FURL group ＞ URL group,P ＜ 0.05).Postoperative hospitalization days of RLU group,PCNL group,URL group and FURL group were (6.5 ± 0.6) d,(9.5 ± 0.7) d,(8.4 ± 0.7) d and (7.7 ± 0.7) d respectively,and there were significant differences in terms of hospitalization days (RLU group ＞ PCNL group ＞ FURL group ＞ URL group,P ＜ 0.05).The calculi clearance rates of RLU group,PCNL group,URL group and FURL group were 79.5％,100.0％,94.4％ and 88.4％ at 3 days after operation,and 82.1％,100.0％,97.2％ and 95.3％ at 1 month after operation.The postoperative calculi clearance rates at 3 days and 1 month in RLU group were higher than those in URL group(P ＜ 0.05),but there was no difference between PCNL group and RLU group (P ＞ 0.05).Postoperative ESWL rates of RLU group,PCNL group,URL group and FURL group were 12.8％,0,2.8％ and 4.7％,and there was no difference among the four groups.The decreased value of RBC in PCNL group and FURL group was higher than that of URL group and RLU group(P ＜ 0.05).One patient in PCNL group suffered from massive hemorrhage,and required blood transfusion.The complication rates in the four groups were 23.1％ (9/39),9.4％ (3/32),13.9％ (5/36) and 9.3％ (4/43) respectively,and there was no difference of complication among them(P ＞ 0.05).Conclusions Four types of endoscopes have the advantages of safety,small wound and quick recovery for ureter calculi larger than 1 cm.The URL operation is simple,with less injury,quick recovery,but low stone clearance rate.FURL requires high level of skill for the operator,and is an effective treatment for ureteric,renal pelvic,and kidney stones which are smaller than 2 cm.FURL avoids the extra ESWL treatment,but costs much.PCNL has more injury and requires high-level surgical skills with a high stone clearance rate.RLU has a high stone clearance rate but is much difficult,which can be used as a remedy for the failure of FURL or PCNL.