经尿道直出绿激光汽化术和经尿道电切术治疗直径<3 cm输尿管囊肿患者安全性和有效性的比较研究  

Safety and efficacy of transurethral front-firing greenlight laser vapor- resection and transurethral resection for the ureterocele <3 cm in diameter

作　　者：钟瑞伦[1] 陈波特[1] 张化儒 杨国胜[1] 邱晓拂[1] 王炳卫[1] 刘百川[1] 张涛 李高远[1] 刘跃加 ZHONG Ruilun;CHEN Bote;ZHANG Huaru;YANG Guosheng;QIU Xiaofu;WANG Bingwei;LIU Baichuan;ZHANG Tao;LI Gaoyuan;LIU Yuejia(Department of Urology,Guangdong Second Provincial General H ospital,Guangzhou,510317,China)

机构地区：[1]广东省第二人民医院泌尿外科

出　　处：《临床泌尿外科杂志》2019年第11期879-882,887,共5页Journal of Clinical Urology

基　　金：广州市科技计划项目(编号201804010087)

摘　　要：目的:探讨经尿道直出绿激光汽化术(GLL-VR)和经尿道电切术(TUR)治疗直径<3 cm输尿管囊肿患者的有效性和安全性。方法:回顾性分析我院2013年9月~2018年2月诊治的25例直径<3 cm输尿管囊肿患者的临床资料,根据采取的术式不同,分成GLL-VR组(n=14)和TUR组(n=11),比较分析2种术式患者的术前基本资料、围手术期指标、并发症和疗效指标。结果:所有手术均由同一经验丰富的医师完成,术后随访至少6个月。GLL-VR组与TUR组术前资料比较差异无统计学意义(P>0.05);两组在手术时间[(26.6±4.2)min vs.(30.5±2.9)min]、手术前后血红蛋白浓度减少量[(0.6±0.2)g/L vs.(0.9±0.3)g/L]、血清Na^+减少量[(0.7±0.3)mmol/L vs.(1.0±0.3)mmol/L]、导尿管拔除时间[(2.1±0.3)d vs.(3.1±0.4)d]和术后住院时间[(3.4±0.5)d vs.(4.2±0.7)d]等方面比较差异均有统计学意义(P<0.05)。GLL-VR组中仅1例输尿管反流;TUR组中2例发生闭孔神经反射,1例发生输尿管反流,2例发生输尿管开口狭窄;两组总并发症发生率比较差异有统计学意义[7.1%(1/14)vs.45.5%(5/11),P<0.05]。两组在一次性治愈率(92.9%vs.45.5%)、复发率(0 vs.36.4%)及疗效方面比较差异均有统计学意义(P<0.05)。结论:与TUR相比,GLL-VR治疗<3 cm输尿管囊肿患者,具有围手术期安全、并发症少和疗效肯定等优点,是一种安全有效的改良腔内微创新术式。Objective:To explore the safety and efficacy of transurethral front-firing greenlight laser vapor-resection and transurethral resection for the ureterocele<3 cm in diameter.Method:The clinical data of 25 patients with ureterocele<3 cm in diameter diagnosed and treated in our hospital from September 2013 to February 2018 were retrospectively analyzed.According to the different surgical methods adopted,the patients were divided into two groups:transurethral front-firing greenlight laser vapor-resection(GLL-VR group,n=14)and transurethral resection(TUR group,n=11).The basic preoperative data,perioperative indicators,complications and efficacy indexes of the two groups were compared and analyzed.Result:All surgeries were successfully performed by one experienced chief surgeon and 6 months of follow-up were completed after surgery at least.The results of GLL-VR group and TUR group showed as followed.There was no significant difference in preoperative data between the two groups(P>0.05).The operation time were[(26.6±4.2)min vs.(30.5±2.9)min],and the reduction of hemoglobin concentration before and after surgery were[(0.6±0.2)g/L vs.(0.9±0.3)g/L].The decrease of serum Na^+were[(0.7±0.3)mmol/L vs.(1.0±0.3)mmol/L],and catheter removal time were[(2.1±0.3)d vs.(3.1±0.4)d].Postoperative hospitalization time were[(3.4±0.5)d vs.(4.2±0.7)d].The difference of them was significant between the two groups(P<0.05).There was only 1 case of vesicoureteral reflux in GLL-VR group,2 cases of obturator nerve reflex,1 case of vesicoureteral reflux and 2 cases of ureteral orifice stricture in TUR group.There was significant difference in total complications between GLL-VR group and TUR group[7.1%(1/14)vs.45.5%(5/11),P<0.05].The difference of therapeutic indicators showed statistically significant between two groups(P<0.05).One-time cure rate were(92.9%vs.45.5%),and recurrence rate were(0 vs.36.4%).Conclusion:Compared with TUR,GLL-VR has the advantages of perioperative safety,less complications and definite curative effect for pati

关 键 词：输尿管囊肿 经尿道直出绿激光汽化术 经尿道电切术 

分 类 号：R693[医药卫生—泌尿科学]