微创经皮肾镜取石术和单孔后腹腔镜输尿管切开取石术治疗输尿管上段结石的对比研究  

Comparison Between Minimally Invasive Percutaneous Nephrolithotomy and Single-site Retroperitoneal Ureterolithotomy on Upper Ureteral Calculi

作　　者：林立国[1] 吴国忠[1] 孙忠凯[1] 蔡浩榕[1] 丁国栋[1] 

机构地区：[1]广东省梅州市人民医院泌尿外科,514031

出　　处：《中国全科医学》2015年第17期2050-2053,共4页Chinese General Practice

基　　金：梅州市科技局计划项目(2013B07)

摘　　要：目的探讨微创经皮肾镜取石术(MPCNL)和单孔后腹腔镜下输尿管切开取石术(Less-RU)治疗输尿管上段结石的优缺点,为患者选择最适合的术式提供依据。方法选取2009年1月—2013年12月梅州市人民医院收治的输尿管上段结石患者100例,根据患者采用的手术方法分为MPCNL组(69例)和Less-RU组(31例)。两组患者均经过术前准备,分别接受MPCNL和Less-RU,观察两组患者手术时间、术中血红蛋白下降量、结石清除率、术后肉眼血尿持续时间、术后下床活动时间、住院时间、返回工作时间、满意度和严重并发症发生情况。结果两组患者均获得成功治疗,无一例患者死亡。MPCNL组3例患者因输尿管扭曲或合并狭窄行MPCNL失败后改行开放手术,3例患者结石残留,1例患者输尿管狭窄;Less-RU组3例患者因操作困难额外增加一个操作通道,无一例患者有结石残留。Less-RU组手术时间长于MPCNL组,术中血红蛋白下降量小于MPCNL组,术后肉眼血尿持续时间、术后下床活动时间、住院时间、返回工作时间均短于MPCNL组(P<0.05);两组满意度比较,差异有统计学意义(P<0.05)。MPCNL组术后发生大出血1例,严重感染10例;Less-RU组无严重并发症发生。结论 Less-RU治疗输尿管上段结石安全、可行、有效并且术后恢复快、并发症少,在医疗技术和设备条件允许的情况下,Less-RU可作为输尿管中上段较大结石的首选治疗方法。Objective To investigate advantages and disadvantages of minimally invasive pereutaneous nephrolithotomy （MPCNL） and single - site retroperitoneal ureterolithotomy（ Less - RU） on large upper ureteral calculi and to provide references for selecting proper operation method for patients. Methods We enrolled 100 patients with upper ureteral calculi who were admitted into Meizhou People′s Hospital from January 2009 to December 2013. The patients were divided into two groups：MPCNL group（ n=69 ） and Less -RU group （ n =31 ）. The two groups both made preoperative preparation and received MPCNL or Less-RU. The operation duration,decrease in hemoglobin,clearance rate of calculi,gross hematuria duration after sugery,time before being off sickbed,hospital stay,time before being back at work,satisfaction degree,the occurrence of serious complication were observed. Results The two groups both had successful treatment with no patient dead. In MPCNL group,three patients discontinued to receive open operation after the failure of MPCNL due to the contort or combined stenosis of ureter,three patients had calculus remains,and one patient had stenosis in ureter. In Less-RU group,three patients were operated with an extra surgery passage due to operation difficulty,and no patient had calculi remains. Less -RU group had longer（P〈0. 05）surgery duration and smaller（P〈0. 05）decrease in hemoglobin than MPCNL group. Less-RU group also had shorter（P〈0. 05）gross hematuria duration after sugery,time before being off sickbed after surgery,hospital stay,time before being back at work than MPCNL group. The two groups were significantly different（P〈0. 05）in satisfaction degree. In MPCNL group,massive haemorrhage occurred in one patient, and serious infection occurred in ten patients. In Less - RU group,no serious complication occurred. Conclusion Less - RU was safe, feasible and effective with rapid postoperative recovery and few complications for the treatment of upper ureteric calculi. If the needed m

关 键 词：输尿管结石 肾造口术 经皮 单孔后腹腔镜输尿管切开取石术 

分 类 号：R693.4[医药卫生—泌尿科学]