微创经皮肾镜术及腹腔镜下输尿管切开取石术治疗输尿管上段结石临床效果观察  

Clinical effect observation of minimally invasive percutaneous nephrolithotomy and retroperitoneal laparoscopic ureterolithotomy in the treatment of upper ureteral calculi

作　　者：孙霆[1] 张章 张琪琳 付剑 SUN Ting;ZHANG Zhang;ZHANG Qi-lin;FU Jian(The Second Department of General Surgery,Dayi County People's Hospital,Chengdu 611330,China)

机构地区：[1]四川省大邑县人民医院普外二科

出　　处：《实用医院临床杂志》2019年第5期91-94,共4页Practical Journal of Clinical Medicine

摘　　要：目的探讨微创经皮肾镜术(MPCNL)与后腹腔镜下输尿管切开取石术(RLU)治疗输尿管上段结石的疗效及并发症。方法76例输尿管上段结石患者,按照随机数字表法分为对照组与观察组各38例,对照组行MPCNL治疗,观察组行RLU治疗,比较两组手术情况、并发症情况、术后早期应激指标及肾功能指标情况。结果观察组手术时间长于对照组,术中出血量少于对照组,下床活动时间与术后住院时间短于对照组(P<0.05),两组单次清石率比较差异无统计学意义(P>0.05);观察组并发症发生率低于对照组(P<0.05);术后1 d,两组皮质醇(Cor)、C反应蛋白(CRP)、白细胞计数(WBC)、血尿氮素(BUN)、血肌酐(SCr)、胱抑C(CysC)及脂质运载蛋白(NAGL)水平较术前升高,观察组上述指标均低于对照组(P<0.05)。结论输尿管上段结石患者行MPCNL或RLU治疗均可获得良好疗效,相较于MPCNL,RLU具有术后恢复快、应激刺激小、损伤少的优势。Objective To observe the efficacy and complications of minimally invasive percutaneous nephrolithotomy(MPCNL)and retroperitoneal laparoscopic ureterolithotomy(RLU)in the treatment of upper ureteral calculi.Methods Seventy-six patients with upper ureteral calculi were randomly divided into control or observation group according to the random number table method,38 in each group.The control group was given MPCNL and the observation group was given RLU.The operation status,complications,early postoperative stress indexes and renal function indexes were compared between the two groups.Rescults The operative time was longer,the intraoperative blood loss was less,the ambulation time and the postoperative hospital stay were shorter in the observation group than those in the control group(P<0.05).There was no significant difference in the single stone removal rate between the two groups(P>0.05).The incidence rate of complications in the observation group was significantly lower than that in the control group(P<0.05).After 1 day of operation,the levels of stress indexes of cortisol(Cor),C-reactive protein(CRP)and white blood cell count(WBC)in the two groups were significantly increased compared with those before operation(P<0.05),and the levels of Cor,CRP and WBC in the observation group were significantly lower than those in the control group(P<0.05).The levels of renal function indexes such as blood urea nitrogen(BUN),serum creatinine(SCr),cystatin C(CysC)and neutrophil gelatinase-associated lipocalin(NAGL)after 1 day of operation were significantly increased compared with those before operation(P<0.05).The levels of BUN,Scr,CysC and NGAL in the observation group were significantly lower than those in the control group(P<0.05).Conclusion Both MPCNL and RLUP can achieve good results in patients with upper ureteral calculi.Compared with MPCNL,RLU has the advantages of rapid postoperative recovery,small stress stimulation and little damage.

关 键 词：微创经皮肾镜术 腹腔镜下输尿管切开取石术 输尿管上段结石 并发症 

分 类 号：R693.4[医药卫生—泌尿科学]