后腹腔镜手术治疗高龄输尿管结石48例  

Retroperitoneal Laparoscopic Surgery in the Treatment of 48 elderly Cases with Ureteral Calculi

作　　者：何幸福[1] 李见波[1] 田彬[1] 

机构地区：[1]四川省遂宁市中医院泌尿外科,遂宁629000

出　　处：《中国中西医结合外科杂志》2017年第1期33-36,共4页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

摘　　要：目的:探讨后腹腔镜手术治疗高龄输尿管结石的疗效。方法:选择96例高龄输尿管上段结石患者,按随机数字表分为观察组与对照组各48例。观察组采取后腹腔镜输尿管切开取石术,对照组行输尿管镜术。比较两组手术成功率、结石清除率、手术时间、术中出血量、术后首次排气时间、住院时间、术前及术后第3 d的血清C反应蛋白(CRP)、白细胞介素6(IL-6)、皮质醇(Cor)水平、并发症发生率。结果:观察组结石清除率100%,高于对照组的91.3%(P<0.05)。观察组手术时间(1.4±0.5)h,长于对照组;术中出血量(28.2±5.0)m L,少于对照组(均P<0.05)。观察组首次排气时间与住院时间为(1.1±0.5)d、(5.3±0.9)d,少于对照组的(1.7±0.8)d、(7.2±1.1)d(均P<0.05)。观察组术后第3 d的CRP、IL-6、Cor分别为(30.3±5.4)mg/L、(17.1±4.4)ng/L、(231.5±23.4)ng/m L,高于本组治疗前与对照组术后第3 d(均P<0.05)。观察组术后并发症发生率8.7%,对照组为10.9%。结论:后腹腔镜输尿管切开取石术治疗高龄输尿管上段结石,具有较高结石清除率,且创伤小,术中出血与并发症少,术后恢复快,应激反应轻,为安全、有效的治疗手段。ObjectiveTo investigate the effects of retroperitoneal laparoscopic ureteral operation in thetreatment of elderly patients with ureteral calculi.MethodsNinety-six elderly patients with upper ureteralcalculi were selected as study subjects and randomized into the observation group and the control group, 48 cas-es in each group. The observation group was treated by retroperitoneal laparoscopic ureterolithotomy while thecontrol group treated by ureteroscopic operation. The success rate of operation, stone clearance rate, operationtime, intraoperative blood loss, postoperative initial anal exhaust time, hospitalization time, CRP levels preopera-tive and postoperative, interleukin 6（IL-6） and cortisol（Cor） and the incidence of postoperative complicationswere compared between the two groups.ResultsThe stone clearance rate in the observation group was 100%,which was higher than that in the control group（91.3%）（P〈0.05）. The operation time of the observation groupwas（1.4 ± 0.5） h, longer than that in the control group（P〈0.05）. The amount of bleeding during operation was（28.2 ± 5.0） m L in the observation group, lower than that in the control group（P〈0.05）. The first exhaust timeand hospitalization time of the observation group were（1.1±0.5） d and（5.3±0.9） d, less than that of the controlgroup [（1.7±0.8） d,（7.2±1.1） d, respectively]. The CRP, IL-6, and Cor in the observation group were[（30.3±5.4）mg/L,（17.1±4.4） ng/L and（231.5±23.4） ng/m L], higher than that in the control group. The incidence of postopera-tive complications was 8.7% in the observation group and 10.9% in the control group.ConclusionRetroperi-toneal laparoscopic ureterolithotomy for the treatment of elderly patients with upper ureteral calculi had the ad-vantage of high stone clearance rate, less trauma, and bleeding, fewer complications, faster postoperative recov-ery and less stress reactions. It was a safe and effective therapeutic method.

关 键 词：输尿管结石 高龄 腹腔镜 应激 

分 类 号：R693.4[医药卫生—泌尿科学]