输尿管镜碎石术、微造瘘经皮肾镜碎石取石术和腹腔镜下输尿管切开取石术治疗输尿管上段复杂性结石的疗效分析  

The curative effect of ureteroscopic lithotripsy,mini-fistulation percutaneous nephrolithotomy and laparoscopic ureterolithotomy in the treatment of complex upper ureteral stones

作　　者：廖艳[1] 胥国微 廖娟[2] LIAO Yan;XU Guo-wei;LIAO Juan(Institute of Urology/Urology,West China Hospital,Sichuan University,Chengdu 610041,China;Center for Infectious Diseases,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院泌尿外科/泌尿外科研究所,四川成都610041 [2]四川大学华西医院感染性疾病中心,四川成都610041

出　　处：《实用医院临床杂志》2020年第2期144-147,共4页Practical Journal of Clinical Medicine

摘　　要：目的比较输尿管镜碎石术、微造瘘经皮肾镜碎石取石术和腹腔镜下输尿管切开取石术治疗输尿管上段复杂性结石的疗效。方法选取120例输尿管上段复杂性结石患者,采用随机数字表法分为A组(输尿管镜碎石术)、B组(微造瘘经皮肾镜碎石取石术)、C组(腹腔镜下输尿管切开取石术)各40例,比较三组围术期相关指标(手术时间、术中出血量、术后住院时间、结石一次性清除率、住院费用)、围术期视觉模拟疼痛评分(VAS)、并发症及随访复发率。结果A、B、C组手术时间依次延长,B组术中出血量、住院费用大于A、C组,B组术后住院时间长于A、C组,B、C组结石一次性清除率高于A组(P<0.05),术后1、3 d B组VAS评分高于A、C组,C组并发症总发生率低于A、B组(P<0.05)。结论与输尿管镜碎石术、微造瘘经皮肾镜碎石取石术相比较,腹腔镜下输尿管切开取石术因具有术中出血量少、住院费用低、围术期疼痛轻和术后并发症少等优势,成为输尿管上段复杂性结石患者有效治疗手段。Objective To compare the curative effect of ureteroscopic lithotripsy(URL),mini-fistulation percutaneous nephrolithotomy(PCNL)and laparoscopic ureterolithotomy in the treatment of complex upper ureteral stones.Methods One hundred and twenty patients with complex upper ureteral stones were divided into group A(URL),group B(mini-fistulation PCNL)and group C(laparoscopic ureterolithotomy)by random number table method,40 in each group.The perioperative related indexes(operation time,intraoperative blood loss,postoperative hospitalization time,one-time clearance rate of stone,hospitalization cost),the score of perioperative visual analogue scale(VAS),and the complications and recurrence rate of follow-up were compared among three groups.Results The operation time of the group A,the group B and the group C was prolonged in turn.The intraoperative blood loss and hospitalization cost in the group B were significantly higher than those in the group A and C,and postoperative hospitalization time was significantly longer than that in the group A and C.The one-time clearance rate of stones in the group B and C was significantly higher than that in the group A(P<0.05).After 1 day and 3 days of surgery,VAS scores of the group B were significantly higher than those of the group A and C(P<0.05).The total incidence of complications in the group C was significantly lower than that in the group A and B(P<0.05).Conclusion Compared with URL and mini-fistulation PCNL,there are advantages of laparoscopic ureterolithotomy such as little intraoperative blood loss,low hospitalization costs,mild perioperative pain and few postoperative complications,making it become and effective treatment method for patients with complex upper ureteral stones.

关 键 词：输尿管上段复杂性结石 输尿管镜碎石术 微造瘘经皮肾镜碎石取石术 腹腔镜下输尿管切开取石术 

分 类 号：R693.4[医药卫生—泌尿科学]