摘要
目的:分析4种不同腔镜术式治疗输尿管上段结石的临床疗效。方法:回顾性分析2016年2月-2018年1月192例输尿管上段结石行4种不同术式治疗患者的临床资料。根据术式不同,分为输尿管硬镜碎石术(URL)组、后腹腔镜输尿管切开取石术(RLU)组、微创经皮肾镜取石术(mPCNL)组和输尿管软镜碎石术(RIRS)组。比较4组手术时间、术中出血量、术后住院时间、并发症和术后1个月结石清除率等。结果:4组在性别、年龄、结石位置等方面比较,差异均无统计学意义。RLU组和mPCNL组结石直径明显大于URL组和RIRS组。URL组、RLU组、mPCNL组和RIRS组手术时间分别为(53. 1±12. 8)、(72. 1±12. 9)、(63. 3±14. 0)和(59. 8±13. 9) min,4组间比较RLU组手术时间最长。术中出血量分别为(21. 1±20. 6)、(39. 2±18. 9)、(94. 2±47. 2)和(23. 0±15. 8) mL;其中mPCNL组1例术后需要输血治疗,其余患者均未输血。URL组、RLU组、mPCNL组和RIRS组术后住院时间分别为(3. 6±1. 8)、(7. 8±2. 3)、(8. 5±1. 9)和(3. 2±1. 1) d,4组间比较差异有统计学意义。术后1个月结石清除率分别为87. 1%、100%、95. 8%和96. 4%,RLU组术后1月结石清除率均显著高于URL组,但mPCNL组与RLU组间术后1个月结石清除率比较,差异均无统计学意义。4组总体并发症发生率分别为15. 1%、4. 3%、20. 8%、10. 7%,差异无统计学意义。结论:URL损伤最小、术后恢复快,且可同时处理双侧病变;RLU并发症少、一次性取石成功率高,可同时处理肾盂输尿管疾病,但技术要求较高;mPCNL结石靠近肾盂而肾积水又比较明显或者合并肾结石,但是出血和感染等并发症较高;RIRS对输尿管结石上移至肾盂或肾盏的结石有绝对优势,可作为URL和mPCNL的有效补充。
Objective: To analyze the clinical efficacy of different kinds of endoscopic methods in the treatment of upper ureteral calculi.Methods: From February 2016 to January 2018, 192 patients with upper ureteral calculi were analyzed. According to the different surgical methods, patients were divided into four groups: ureteroscopic lithotripsy(URL), retroperitoneal laparoscopic ureterolithotomy(RLU), minimally percutaneous nephrolithotomy(mPCNL) and retrograde intrarenal surgery(RIRS).The operative time, intra-operative blood loss, postoperative hospitalization time, complications and calculi clearance rate were compared among the four groups.Results: There was no statistically significant difference among the four groups in terms of gender, age, and stone location. The diameter of calculi in RLU group and mPCNL group was much larger than those in URL group and RIRS group.The operation time of the URL group, RLU group, mPCNL group and RIRS group were(53. 1±12. 8),(72. 1± 12. 9),(63. 3± 14. 0), and(59. 8± 13. 9) min, respectively, and that of RLU group was the longest. The intra-operative blood loss was(21. 1±20. 6),(39. 2±18. 9),(94. 2±47. 2) and(23. 0±15. 8) mL, respectively. One patient in the mPCNL group required blood transfusion after operation, and the other patients did not receive blood transfusion. The postoperative hospital stays in the URL group, RLU group, mPCNL group and RIRS group were(3. 6±1. 8),(7. 8±2. 3),(8. 5±1. 9) and(3. 2± 1. 1) d, respectively, and there were statistically significant among the four groups.Calculus clearance rates were respectively 87. 1%, 100%, 95. 8%, and 96. 4% one month after operation, and the stone clearance rate in the RLU group was significantly higher than that in the URL group, but there was no significant difference in the rate of stone clearance between mPCNL group and RLU group(P>0. 05). The overall complication rates of the four groups were 15. 1%, 4. 3%,20. 8%, and 10. 7%, respectively, without significant difference.Conclusion: URL operation is simple,with less invasion and quick recovery,and can solve the problems of low stone clearance rate and bilateral lesions at the same time. RLU has fewer complications and high success rate of one-time stone removal. Meanwhile, RLU can treat pelvic ureteral disease, but the technical requirements are higher. The mPCNL is adopted when stones are close to renal pelvis accompanied with obvious hydronephrosis or combined with kidney stones, but the complications such as bleeding and infection are more. RIRS has an absolute advantage in the ureteral stones that move to renal pelvis, so it can be an effective supplement of URL or mPCNL.
作者
侯彦广
刘修恒
刁长会
王潇
HOU Yanguang;LIU Xiuheng;DIAO Changhui;WANG Xiao(Dept. of Urology,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)
出处
《武汉大学学报（医学版）》
CAS
2019年第2期297-301,共5页
Medical Journal of Wuhan University
