| Purpose:This study focused on the efficacy and safety of retroperitoneoscopic ureterolithotomy(RLUL),minimally invasive percutaneous nephrolithotomy(MPCNL),and flexible ureteroscope lithotripsy(FURL)for the treatment of upper impacted ureteral calculi.Methods:Retrospective analysis of 156 cases of ureteral impacted calculi underwent minimally invasive surgery in the Department of Urology,First Affiliated Hospital of Nanchang University from December 2015 to June 2017,of which 50 cases were treated with RLUL and 56 cases were treated with MPCNL.FURL group 50 cases.The intraoperative and postoperative correlation indexes of each group were compared: surgical time,blood loss,stone clearance rate,postoperative hospital stay,postoperative bed rest time,incidence of surgical complications,and postoperative adjuvant treatment rate.Results:1.There was no significant difference in the three groups of stone diameter,gender,age,stone location,creatinine,kidney collection system separation degree(P>0.05).2.The operative time of RLUL,MPCNL and FURL were 109.6±22.99 min,55.46±24.04 min and 53.08±13.12 min,respectively.The difference was statistically significant(P<0.05).The RLUL operation time was significantly longer than the MPCNL group and the FURL group.3.The blood loss in RLUL,MPCNL and FURL were 29.7±6.81 ml,61.07±11.39 ml,and 4.52±1.47 ml,respectively.The difference was statistically significant(P<0.05).There were more intraoperative hemorrhages in the MPCNL group than in the RLUL group and the FURL group.4.The hospitalization time of RLUL,MPCNL,FURL were 3.92±1.47 d,5.62±1.15 d,and 1.94±0.74 d,respectively.The difference was statistically significant(P<0.05).Postoperative hospital stay was significantly shorter in the FURL group than in the RLUL group and the MPCNL group.5.The bed rest time after RLUL,MPCNL and FURL were 25.02±12h,71.2±7.36 h and 10.3±1.41 h,respectively.The difference was statistically significant(P<0.05).The bed rest time in the FURL group was significantly shorter than that in the RLUL and MPCNL groups.6.(1)RLUL,MPCNL,and FURL were used to treat patients with large upper impacted ureteral stones(≥15mm).The stone clearance rates of 3 days after operation were 90.6%,88.2%,and 64.5%,respectively.The difference was statistically significant(P<0.05).The stone clearance rates were 96.9%,97%,and 77.4% respectively in the first month after operation,and the difference was statistically significant(P<0.05).(2)RLUL,MPCNL,FURL were used to treat patients with upper impacted ureteral calculi with moderate or severe hydronephrosis.The clearance rates of 3 days after operation were 83.3%,80%,and 53.8%,respectively,and the difference was statistically significant(P<0.05).The stone clearance rates were 95.8%,93.3%,and 69.2% respectively in the first month after operation,and the difference was statistically significant(P<0.05).(3)RLUL,MPCNL,FURL treatment of upper impacted ureteral stone in fat patients,the stone clearance rates of 3 days after operation were 80.7%,55.2%,83.8%,the difference was statistically significant(P <0.05).The stone clearance rates in 1 month after operation were 96.2%,69%,and 93.5%,respectively.The difference was statistically significant(P<0.05).7.The incidence of surgical complications in the three groups was not statistically significant(P>0.05).8.There was no significant difference in the rate of adjuvant therapy between the three groups(P>0.05).Conclusions:1.FURL,MPCNL,RLUL three kinds of surgical methods have a good effect on the upper impacted ureteral calculi.2.FURL has less trauma,quick postoperative recovery,and is easily accepted by patients.It has a good effect on fat patients with small stones diameter(<15mm).3.For patients with larger stone diameter(≥15mm),MPCNL and RLUL have obvious advantages.MPCNL is a better choice for patients with kidney stones.4.RLUL is suitable for all patients with upper impacted ureteral calculi,especially for patients with moderate to severe hydrocephalus.. |
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