摘要目的 比较经尿道输尿管镜碎石术(URL)、经皮肾穿刺取石术(MPCNL)及腹腔镜输尿管切开取石术(LU)治疗嵌顿性输尿管上段结石的疗效和安全性.方法 2012年1月至2017年10月收治的229例单侧嵌顿性输尿管上段结石患者分别采用输尿管镜碎石术、经皮肾镜取石术及腹腔镜下输尿管切开取石术治疗,比较三组手术时间、出血量、术后住院天数、并发症、术后3d及1个月的结石清除率等.结果 三组间出血量比较差异有统计学意义(URL组＜LU组＜MPCNL组,P＜0.05).三组间并发症比较差异未见统计学意义(P＞0.05).术后住院时间URL组明显优于MRCNL组及LU组(P＜0.05). MPCNL组及LU组在需ESWL治疗的例数、术后3 d及术后1个月的结石清除率均优于URL组(P均＜0.05),但MPCNL组与LU 组比较差异未见统计学意义(P＞0.05).结论 三种手术方式治疗嵌顿性输尿管上段结石均取得了较好的疗效,主要并发症的发生率大致相同,LU、MPCNL治疗嵌顿性输尿管上段结石均有很高的结石清除率,URL结石清除率稍低.

abstractsObjective To compare the efficacy and safety of transurethral ureteroscope lithotrip-sy(URL), the minimally invasive percutaneous nephrolithotomy (MPCNL) and laparoscopic ureterolithot-omy(LU) in treating impacted upper ureteric calculi.Methods A total of 229 cases of upper ureteral calculi from Jan 2012 to Oct 2017 were treated with ureteroscopic lithotripsy , percutaneous nephrolithoto-my and laparoscopic ureterolithotomy.The operation time, bleeding volume , postoperative hospitalization time, postoperative complications , the stone clearance rates at 3 days and 1 month after operation were compared.Results There were significant differences in the amount of bleeding among the three groups (URL group ＜LU group ＜MPCNL group, P＜0.05).There was no significant difference in the compli-cations among the three groups (P＞0.05).The postoperative hospitalization time of LU group was sig-nificantly better than that of MPCNL group and URL group (P＜0.05).In MPCNL group and LU group, the number of cases requiring ESWL treatment , the stone clearance rates of 3 d after operation and 1 months after operation were all better than those in URL group (P＜0.05), but there was no significant difference between the MPCNL group and LU group (P＞0.05).Conclusions All of the three methods achieved good effects on impacted upper calculi , with no significant differences in the rate of postopera-tive complications.High stone-free rate can be obtained MPCNL and LU for impacted upper ureteral cal-culi.The stone-free rate is slightly lower with URL.