目的：探讨后腹腔镜输尿管切开取石术(retroperitoneal laparoscopic ureterolithotomy，RLU)治疗输尿管中上段结石的临床效果，以及其对患者应激指标和肾功能指标的影响。方法：选取四川省八一康复中心2015年1月至2016年6月收治的输尿管中上段结石患者160例，依照随机数字表法分为2组，每组80例，其中观察组采取RLU术治疗，对照组采用经皮肾镜取石(percutaneous nephrolithotomy，PNL)术治疗。比较两组手术情况及术后并发症情况，观察两组患者手术前后血清CRP、内皮素-1(endothelin-1，ET-1)、皮质醇(cortisol，Cor)、血肌酐(serum creatinine，SCr)、胱抑素C(cystatin C，CysC)及脂质运载蛋白(neutrophil gelatinase-associated lipocalin，NAGL)水平的变化。结果：观察组患者手术时间明显长于对照组，术中出血量、卧床时间以及住院时间则显著小于对照组，差异有统计学意义(P<0.05)。两组结石清除率比较差异无统计学意义(P>0.05)。与术前比较，术后1 d两组CRP，ET-1，Cor水平以及SCr，CysC，NAGL水平均显著升高，差异有统计学意义(P<0.05)；且术后两组间各指标比较，对照组高于观察组，差异有统计学意义(P<0.05)。观察组术后并发症发生率低于对照组，差异有统计学意义(P<0.05)。结论：与PNL相比，RLU术治疗输尿管中上段结石疗效确切，具有出血少、恢复快、结石清除率高、术后并发症少等优点，且对患者应激反应和肾功能的影响较小。
Effect of retroperitoneal laparoscopic ureterolithotomy on mid-upper ureteral calculi
Objective: To explore the clinical effect of retroperitoneal laparoscopic ureterolithotomy (RLU) for mid-upper ureteral calculi and to study the effect on stress reaction and renal function. Methods: A total of 160 patients with mid-upper ureteral calculi in Sichuan 81 Rehabilitation Center from January 2015 to June 2016 were enrolled in this study. Eighty patients in the observation group were treated with RUL and 80 patients in the control group were treated with percutaneous nephrolithotomy (PNL). The situation of operation and postoperative complications were compared and the changes of stress reaction and renal function indexes were observed. Results: The operation time in the observation group was longer than that in the control group, while the blood loss, time in bed and hospital stay in the observation group were significantly shorter than those in the control group (P<0.05). There was no significant difference in stone clearance rate between two groups (P>0.05). The levels of CRP, endothelin-1 (ET-1), cortisol (Cor) and serum creatinine (SCr), cystatin C (CysC), neutrophil gelatinase-associated lipocalin (NAGL) increased significantly in the two groups (P<0.05) and those indexes in the observation group were significantly lower than those in the control group (P<0.05). The occurrence rate of postoperative complications in observation group was lower than that in control group (P<0.05). Conclusion: Compared with PNL, RLU has exact effect in treating mid-upper ureteral calculi. It has great advantages of less blood less, rapid recovery, high stone clearance rate and less postoperative complications. The effects of RLU on stress reaction and renal function are small.