输尿管镜气压弹道碎石术与后腹腔镜输尿管切开取石术治疗输尿管上段结石疗效的比较分析  

Comparative study of therapeutic effects between Pneumatic Lithotripsy （PL） and Retroperitoneal Laparoscopic Ureterolithotomy （RLUL） for upper ureteral calculi

作　　者：殷全忠[1] 袁宝国[1] 赵化利[1] 

机构地区：[1]扬州友好医院泌尿外科,江苏225000

出　　处：《国际泌尿系统杂志》2015年第4期486-489,共4页International Journal of Urology and Nephrology

摘　　要：目的比较输尿管镜气压弹道碎石术与后腹腔镜输尿管切开取石术治疗输尿管上段结石的疗效差异，探讨不同病情下治疗输尿管上段结石的最佳方法。方法回顾性分析2012年10月～2014年7月本院33例后腹腔镜输尿管切开取石术和30例输尿管镜气压弹道碎石术治疗输尿管上段结石的患者的临床资料。比较两组患者的手术时间、术后住院天数、术后镇痛药使用次数、手术成功率、结石清除率及手术并发症等指标。结果与后腹腔镜组相比，输尿管镜组手术时间较短[（62．4±21．7）minvs（81．6±26．5）min]，术后住院天数较短[（4．5±0．8）dvs（9．5±2．0）d]，术后镇痛药使用次数较少[（1．6±0．2）次VS（2．5±0．6）次]，差异有统计学意义（P〈0．05）。而相比于输尿管镜组，后腹腔镜组手术成功率较高（100．0％VS90．O％），结石清除率较高（100．O％vs92．6％），手术并发症发生率较低（3．0％vs10．O％），差异有统计学意义（P〈0．05）。结论后腹腔镜输尿管切开取石术与输尿管镜气压弹道碎石术在输尿管上段结石的治疗上各有优势，前者治愈率高，且术后并发症发生率低，对于包裹嵌顿的结石或其他治疗失败时更是不可替代的治疗方式；而输尿管镜下气压弹道碎石术创伤更小且恢复快，但手术成功率及结石清除率不及后腹腔镜手术，有时需其他治疗辅助。临床中应对不同情况的输尿管上段结石需综合考虑后采取相应合适的治疗方式。Objectives To compare the effectiveness of Pneumatic Lithotripsy （PL） and Retroperitoneal Laparoscopic Ureterolithotomy （RLUL） and explore the best method for patients of upper ureteral calculi in different states. Methods The date of 33 patients by RLUL and 30 patients by PL in our hospital from October 2012 to July 2014 was analyzed retrospectively. Date on the operation time, the hospital stay after operation, usage of the diclofeMac sodium after operation, the operation, successful rate, complication incidence and stone - free rate were compared between the 2 groups. Results Compared to the RLUL group, the PL group had shorter operation time [ （ 62.4 ± 21.7 ） min vs. （ 81.6 ＋ 26.5 ） min I, shorter hospital stay after operation [ （4.5 ± 0.8 ） d vs. （ 9.5 ± 2.0 ） as well as fewer times of diclofenac sodium usage[ （1.6 ± 0.2）vs. （2.5 ±0.6）]. However, the RLUL group had a higher successful rate, a higher stone - free rate and fewer complication incidences after operation. All the differences were statistically significant （ P 〈 0.05 ）. Conclusions RLUL and PL had their own advantages for upper ureteral calculi. RLUL had a high cure rate and less risk of complication, especially for the upper ureter calculi with bigger volume and longer residence time. PL had the advantages of smaller trauma and quicker recovery, but the operation successful rate and the stone - free rate were lower, requiring other aids. Therefore, the best treatment options should be chosen, based on the different states of every patient, after comprehension thought.

关 键 词：输尿管结石 输尿管镜检查 碎石术 腹腔镜检查 

分 类 号：R693.4[医药卫生—泌尿科学]