A clinical study of three kinds minimally invasive surgery treatment of upper ureteral calculus complicating hydronephrosis / 中国医师进修杂志

ABSTRACT

ObjectiveTo explore the efficacy and indications of three kinds minimally invasive surgery treatment of upper ureteral calculus (UUC) complicating hydronephrosis.MethodsFour hundred and ninety-two patients with UUC complicating hydronephrosis were divided into three groupsminimally percutaneous nephrolithotomy (mPCNL) group (310 patients),ureteroscopy lithotripsy(URSL) group ( 130 patients) and retroperitoneal laparoscopic ureterolithotomy (RLU) group (52 patients).The operation time,blood loss,length of stay,stone-free rate and postoperative complications in three groups were compared.ResultsThe stone-free rate was 91.0％(282/310) in mPCNL group,78.5％(102/130) in URSL group and 100.0％(52/52) in RLU group,mPCNL group and RLU group were significantly higher than URSL group (P ＜0.01 ).URSL group and RLU group had the advantage of less operation time,blood loss,length of stay and postoperative complications compared with mPCNL group [ RLU group(55.8 ± 20.5 ) min,( 10.8 ± 3.2)ml,(6.3 ± 2.1 ) d,1.9％(1/52) ;URSL group(56.5 ± 15.2) min,(8.6 ± 1.4) ml,(5.7 ± 1.6) d,1.5％(2/130);mPCNL group(113.8 ±42.5) min,(132.8 ±40.2) ml,(12.5 ±2.4) d,8.4％(26/310),P＜ 0.01 ].Conclusions Minimally invasive surgery on the treatment of UUC is safe and effective.URSL is preferred to treating the small UUC,RLU can improve the success rate for larger UUC.Contrary to mPCNL,which is best for merger kidney calculus,has higher stone-free rate,can be used as supplement of URSL after treatment failure.