三种腹腔镜肾盂输尿管切开取石术治疗孤立肾上尿路结石的疗效比较  

Comparison of three laparoscopic pyelolithotomy/ureterolithotomy for upper urinary tract stones in patients with solitary kidney

作　　者：王晓宁[1] 袁源湖[1] 肖日海[1] 张国玺[1] 邹晓峰[1] 伍耿青[1] 薛义军[1] 龙大治[1] 吴玉婷[1] 刘佛林[1] 刘敏[1] 徐辉[1] 杨军[1] 廖云峰[1] 刘全亮[1] 徐刚[1] 

机构地区：[1]赣南医学院第一附属医院泌尿外科,江西省尿路结石现代治疗中心,江西赣州341000

出　　处：《临床泌尿外科杂志》2013年第12期884-888,共5页Journal of Clinical Urology

基　　金：国家高技术研发计划(863计划)项目(编号2012AA021100);江西省"赣鄱英才555工程"领军人才培养计划项目;江西省科技厅重大科技支撑计划项目(编号20121BBG70032);江西省教育厅科技落地计划项目(编号KJLD12044);江西省卫生厅重大科技计划项目(编号20104008)

摘　　要：目的：比较后腹腔镜（RPL）、经脐单孔腹腔镜（U—LESS）、耻骨上辅助经脐单孔腹腔镜（SA-LESS）肾盂输尿管切开取石术治疗孤立肾上尿路结石的疗效，并探讨其临床应用价值。方法：选择孤立肾上尿路结石患者32例，根据术者经验和患者意愿分为RPL组（12例）、U—LESS组（10例）、SA-LESS组（10例），比较三组手术时间、术中出血量、术后视觉模拟疼痛评分（VAPS）、肠道功能恢复时间、引流管留置时间、并发症发生率、住院时间、患者瘢痕问卷评分（PSAQ）。结果：三组手术均顺利完成，术中术后无严重并发症发生。SA—LESS组和RPL组较U—LESS组手术时间短（P〈0．05），SA-LESS组和U—LESS组患者术后PSAQ低于RPL组（P〈0．01）。三组术中出血量、术后引流管和导尿管留置时间、肠道功能恢复时间、住院时间、VAPS、并发症发生率的差异无统计学意义（P〉0．05）。随访7～40个月，肾积水及肾功能均明显好转，均无结石复发，无输尿管狭窄发生。结论：RPL、U—LESS、SA—LESS三种腹腔镜肾盂输尿管切开取石术治疗孤立肾上尿路结石均安全可行，可成为孤立肾肾盂及输尿管中上段结石的一线治疗方法。SA-LESS美容效果佳，操作较简便，可作为优选。Abstract Objective： To compare surgical outcomes of retroperitoneal laparoscopic pyelolithotomy/uret- erolithotomy （RPL）, transumbilical laparoendoscopic single-site surgery （U-LESS） and suprapubic-assisted lapa- roendoscopic single-site surgery （SA-LESS） for upper urinary tract stones in patients with solitary kidney. Meth- od：There were 32 patients with upper urinary tract stones and solitary kidney in the study. They were divided into three groups （RPL, n=12; U-LESS, n=10; SA-LESS, n=10） according to the experience of the surgeons and the patients＇ wishes. The indices including operative time, intraoperative estimated blood loss, Visual Analog Pain Scale （VAPS）, postoperative intestinal function recovery time, postoperative drainage time, the incidence of com- plications, hospital stay, Patient Scar Assessment Questionnaire （PSAQ） were used to compare among three groups. Result： All the 32 procedures were successfully completed without serious complications. The operative time of SA-LESS and RPL group was shorter than U-LESS group （P〈0.05）. The scores PSAQ for SA-LESS and U-LESS were less than RPL group （P〈0.01）. There was no statistically significant differences in intraoper- ative estimated blood loss, postoperative drainage time, postoperative intestinal function recovery time, hospital stay, VAPS, and the incidence of complications among three groups （P〉0.05）. Degree of hydronephrosis and re nal function improved and no stones recurrence and ureter stenosis were shown in all cases after follow-up period of seven to forty months. Conclusion：Three procedures of RPL, U-LESS and SA-LESS are all safe, feasible and ef- fective for upper urinary tract stones in patients with solitary kidney. They may be the firs-line treatment for pel- vic and upper-middle ureter calculi in patients with solitary kidney. SA-LESS can be the first choice because of good cosmetic and easy-to-operate results.

关 键 词：肾盂结石 输尿管结石 孤立肾 腹腔镜术 

分 类 号：R692[医药卫生—泌尿科学] R693[医药卫生—外科学]