CAJ | 학술논문

目的：比较输尿管镜气压弹道碎石术与后腹腔镜输尿管切开取石术治疗输尿管上段结石的疗效差异，探讨不同病情下治疗输尿管上段结石的最佳方法。方法回顾性分析2012年10月～2014年7月本院33例后腹腔镜输尿管切开取石术和30例输尿管镜气压弹道碎石术治疗输尿管上段结石的患者的临床资料。比较两组患者的手术时间、术后住院天数、术后镇痛药使用次数、手术成功率、结石清除率及手术并发症等指标。结果与后腹腔镜组相比，输尿管镜组手术时间较短[（62．4±21．7）min vs（81．6±26．5） min]，术后住院天数较短[（4．5±0．8）d vs（9．5±2．0）d]，术后镇痛药使用次数较少[（1．6±0．2）次 vs（2．5±0．6）次]，差异有统计学意义（ P ＜0．05）。而相比于输尿管镜组，后腹腔镜组手术成功率较高（100．0％ vs 90．0％），结石清除率较高（100．0％vs 92．6％），手术并发症发生率较低（3．0％ vs 10．0％），差异有统计学意义（ P ＜0．05）。结论后腹腔镜输尿管切开取石术与输尿管镜气压弹道碎石术在输尿管上段结石的治疗上各有优势，前者治愈率高，且术后并发症发生率低，对于包裹嵌顿的结石或其他治疗失败时更是不可替代的治疗方式；而输尿管镜下气压弹道碎石术创伤更小且恢复快，但手术成功率及结石清除率不及后腹腔镜手术，有时需其他治疗辅助。临床中应对不同情况的输尿管上段结石需综合考虑后采取相应合适的治疗方式。
목적：비교수뇨관경기압탄도쇄석술여후복강경수뇨관절개취석술치료수뇨관상단결석적료효차이，탐토불동병정하치료수뇨관상단결석적최가방법。방법회고성분석2012년10월～2014년7월본원33례후복강경수뇨관절개취석술화30례수뇨관경기압탄도쇄석술치료수뇨관상단결석적환자적림상자료。비교량조환자적수술시간、술후주원천수、술후진통약사용차수、수술성공솔、결석청제솔급수술병발증등지표。결과여후복강경조상비，수뇨관경조수술시간교단[（62．4±21．7）min vs（81．6±26．5） min]，술후주원천수교단[（4．5±0．8）d vs（9．5±2．0）d]，술후진통약사용차수교소[（1．6±0．2）차 vs（2．5±0．6）차]，차이유통계학의의（ P ＜0．05）。이상비우수뇨관경조，후복강경조수술성공솔교고（100．0％ vs 90．0％），결석청제솔교고（100．0％vs 92．6％），수술병발증발생솔교저（3．0％ vs 10．0％），차이유통계학의의（ P ＜0．05）。결론후복강경수뇨관절개취석술여수뇨관경기압탄도쇄석술재수뇨관상단결석적치료상각유우세，전자치유솔고，차술후병발증발생솔저，대우포과감돈적결석혹기타치료실패시경시불가체대적치료방식；이수뇨관경하기압탄도쇄석술창상경소차회복쾌，단수술성공솔급결석청제솔불급후복강경수술，유시수기타치료보조。림상중응대불동정황적수뇨관상단결석수종합고필후채취상응합괄적치료방식。
Objectives To compare the effectiveness of Pneumatic Lithotripsy ( PL) and Retroperitoneal Laparoscopic Ureterolithotomy ( RLUL) and explore the best method for patients of upper ureteral calculi in different states.Methods The date of 33 patients by RLUL and 30 patients by PL in our hospital from October 2012 to July 2014 was analyzed retrospectively.Date on the operation time, the hospital stay after operation, usage of the diclofe-nac sodium after operation, the operation, successful rate, complication incidence and stone -free rate were com-pared between the 2 groups.Results Compared to the RLUL group,the PL group had shorter operation time [(62.4 ±21.7)min vs.(816.±26 .5)min],shorter hospital stay after operation[(4.5 ±0.8)d vs.(9.5 ±2.0) as well as fewer times of diclofenac sodium usage[(16.±0 .2)vs.(2 .5 ±0.6)].However, the RLUL group had a higher successful rate, a higher stone-free rate and fewer complication incidences after operation.All the differences were statistically significant( P <0.05).Conclusions RLUL and PL had their own advantages for upper ureter-al calculi.RLUL had a high cure rate and less risk of complication , especially for the upper ureter calculi with bigger volume and longer residence time.PL had the advantages of smaller trauma and quicker recovery, but the operation successful rate and the stone-free rate were lower, requiring other aids.Therefore, the best treatment options should be chosen, based on the different states of every patient, after comprehension thought.