后腹腔镜输尿管切开取石术与微通道经皮肾镜碎石术治疗输尿管上段嵌顿性结石的临床疗效分析
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摘要
目的分析后腹腔镜输尿管切开取石术(RLUL)与微通道经皮肾镜碎石术(m PCNL)治疗输尿管上段嵌顿性结石的临床疗效。方法将103例输尿管上段嵌顿性结石患者按手术治疗方法分为RLUL治疗组50例和m PCNL治疗组53例,比较2组手术时间、术中术后出血量、结石清除率、术后住院时间及并发症发生率。结果两组手术时间、术中出血量及术后住院时间比较差异无统计学意义(均P>0.05)。m PCNL术后出血量(98.13±18.22)m L,RLUL术后出血量(33.95±10.10)m L,两组比较,差异有统计学意义(P<0.05)。RLUL术后并发症发生率为2.0%,m PCNL为15.1%,RLUL组结石清除率100%,m PCNL组为88.7%,两组比较均差异有统计学意义(均P<0.05)。RLUL组有2例结石上移至肾盂,打开肾盂取出结石。其余101例手术均按计划顺利完成。结论 RLUL与m PCNL均是治疗输尿管上段嵌顿性结石安全有效的微创治疗方法,RLUL组具有结石清除率高,术后并发症和出血少的特点,值得临床推荐,但防止结石上移是技术要点。
Objective To compare the efficacy of retroperitoneal laparoscopic ureterolithotomy(RLUL) and mini-invasive percutaneous nephrolithotomy(m PCNL) for the treatment of incarcerated upper ureteral stones. Methods 103 patients with incarcerated upper ureterolithiasis were divided into two groups,RLUL group 50 cases and m PCNL group 53 cases,with RLUL and m PCNL respectively.The surgery time,blood loss in surgery and postoperation,stone clearance rate,hospital stay and incidence of complications were compared. Results There were no significant difference in surgery time,blood loss in surgery and hospital stay between two groups(P >0. 05). The postoperative bleeding volume of m PCNL was(98. 13 ± 18. 22) m L,and RLUL postoperative bleeding volume was(33.95 ± 10. 10) m L. The difference between the two groups was statistically significant(P < 0. 05). The incidence of complications in the RLUL and m PCNL group were 2. 0% and 15. 1% respectively,and stone clearance rate(RLUL 100% vs. m PCNL 88. 7%). There were significant difference between two groups(P < 0. 05). In RLUL group,two patients of calculus moved to the pelvis and the stones were removed from the pelvis. Conclusion Both of the RLUL and m PCNL are efficient therapy for patients with incarcerated upper ureterolithiasis. The RLUL group,with the characteristics of high stone clearance rate,less postoperative bleeding and complications,is worthy of clinical promotion,however,the prevention of stone movement is the key point.
Objective To compare the efficacy of retroperitoneal laparoscopic ureterolithotomy(RLUL) and mini-invasive percutaneous nephrolithotomy(m PCNL) for the treatment of incarcerated upper ureteral stones. Methods 103 patients with incarcerated upper ureterolithiasis were divided into two groups,RLUL group 50 cases and m PCNL group 53 cases,with RLUL and m PCNL respectively.The surgery time,blood loss in surgery and postoperation,stone clearance rate,hospital stay and incidence of complications were compared. Results There were no significant difference in surgery time,blood loss in surgery and hospital stay between two groups(P >0. 05). The postoperative bleeding volume of m PCNL was(98. 13 ± 18. 22) m L,and RLUL postoperative bleeding volume was(33.95 ± 10. 10) m L. The difference between the two groups was statistically significant(P < 0. 05). The incidence of complications in the RLUL and m PCNL group were 2. 0% and 15. 1% respectively,and stone clearance rate(RLUL 100% vs. m PCNL 88. 7%). There were significant difference between two groups(P < 0. 05). In RLUL group,two patients of calculus moved to the pelvis and the stones were removed from the pelvis. Conclusion Both of the RLUL and m PCNL are efficient therapy for patients with incarcerated upper ureterolithiasis. The RLUL group,with the characteristics of high stone clearance rate,less postoperative bleeding and complications,is worthy of clinical promotion,however,the prevention of stone movement is the key point.
引文
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[6]JIANG JT,LI WG,ZHU YP,et al.Comparison of the clinical efficacy and safety of retroperitoneal laparoscopic ureterolithotomy and ureteroscopic holmium laser lithotripsy in the treatment of obstructive upper ureteral calculi with concurrent urinary tract infections[J].Lasers Med Sci,2016,31(5):915-20.
[7]伍季,李云祥,范俊,等.嵌顿性输尿管上段结石的两种微创治疗方法对比研究[J].现代泌尿外科杂志,2011,16(4):328-331.
[8]缪惠东,何中寅,沈锋,等.三种微创手术治疗输尿管上段结石临床观察[J].山东医药,2015,55(28):76-78.
[2]ALEXANDER B,FISHMAN AI,GRASSO M.Ureteroscopy and laser lithotripsy:technologic advancements[J].World Journal of Urology,2015,33:(2):247-256.
[3]马潞林.泌尿外科微创手术学[M].2版.北京:人民卫生出版社,2013:300-303.
[4]吴荣佩,李晓飞,丘少鹏.输尿管上段结石的腔内治疗策略探讨[J].中国内镜杂志,2007,13(12):1250-1252,1256.
[5]ZHAO CM,YANG H,TANG K,et al.Comparison of laparoscopic stone surgery and percutaneous nephrolithotomy in the management of large upper urinary stones:a meta-analysis[J].Urolithiasis,2016,44(6):479-490.
[6]JIANG JT,LI WG,ZHU YP,et al.Comparison of the clinical efficacy and safety of retroperitoneal laparoscopic ureterolithotomy and ureteroscopic holmium laser lithotripsy in the treatment of obstructive upper ureteral calculi with concurrent urinary tract infections[J].Lasers Med Sci,2016,31(5):915-20.
[7]伍季,李云祥,范俊,等.嵌顿性输尿管上段结石的两种微创治疗方法对比研究[J].现代泌尿外科杂志,2011,16(4):328-331.
[8]缪惠东,何中寅,沈锋,等.三种微创手术治疗输尿管上段结石临床观察[J].山东医药,2015,55(28):76-78.