三种腔镜微创手术治疗复杂性输尿管结石疗效观察  

Curative efficacy of three types of endoscopic minimally invasive surgery in treatment of complex ureteral calculi

作　　者：喻小龙 单林林 YU Xiao-long;SHAN Lin-lin(Department of Urology,Xi'an Chang'an Hospital,Xi'an 710016,Shaanxi,CHINA)

机构地区：[1]西安市长安医院泌尿外科,陕西西安710016

出　　处：《海南医学》2020年第7期871-874,共4页Hainan Medical Journal

摘　　要：目的比较三种腔镜微创手术治疗复杂性输尿管结石的疗效,为患者的临床治疗提供指导。方法选择2017年3月至2019年3月西安市长安医院泌尿外科收治的98例复杂性输尿管结石患者作为研究对象,按照随机数表法将患者分为A组、B组和C组,A组32例,采用后腹腔镜输尿管切开取石术(RLU)治疗,B组33例,采用微通道经皮肾穿刺碎石取石术(MPCNL)治疗;C组33例,采用经尿道输尿管镜碎石取石术(URL)治疗。比较三组患者的手术时间、住院费用、术中出血量、术后住院时间、手术成功率、结石清除率、血红蛋白(Hb)水平及并发症发生情况。结果 A组患者的手术时间、住院费用分别为(72.36±18.57) min、(1.08±0.33)万元,明显长于或高于B组的(59.65±16.51) min、(1.01±0.29)万元和C组的(52.37±13.76) min、(0.88±0.27)万元,术中出血量、术后住院时间分别为(43.51±14.37) m L、(3.51±0.86) d,明显少于B组的(58.13±15.24) mL、(4.35±1.14) d和C组的(60.66±16.45) mL、(3.93±1.52) d,差异均有统计学意义(P<0.05),而B组和C组的各手术指标比较差异均无统计学意义(P>0.05);治疗后,A组和B组患者的手术成功率分别为96.88%、93.94%,明显高于C组的78.79%,差异有统计学意义(P<0.05);A组和B组患者的结石清除率分别为93.75%、90.91%,明显高于C组的75.76%,差异有统计学意义(P<0.05),而A组和B组的手术成功率、结石清除率比较差异均无统计学意义(P>0.05);治疗后,三组患者的Hb水平比较差异无统计学意义(P>0.05);治疗后,A组患者的并发症总发生率为12.50%,明显低于B组的24.24%和C组的33.33%,差异均具有统计学意义(P<0.05),而B组和C组患者的并发症总发生率比较差异无统计学意义(P>0.05)。结论复杂性输尿管结石患者采用后腹腔镜输尿管切开取石术术中出血量少、住院时间短,与微通道经皮肾穿刺碎石取石术相比,手术成功率和结石清除率相当,但并发症发生率低,值得�Objective To compare the effect of three kinds of minimally invasive endoscopic surgery in the treatment of complex ureteral calculi. Methods A total of 98 patients with complicated ureteral calculi received in Department of Urology, Xi’an Chang’an Hospital from March 2017 to March 2019 were selected as research objects.The patients were divided into three groups according to the random number table method: group A(32 cases), group B(33 cases), and group C(33 cases), which were treated with retroperitoneal laparoscopic ureterolithotomy(RLU), microchannel percutaneous nephrolithotomy(MPCNL), transurethral ureteroscopic lithotripsy(URL), respectively. The operation time, hospitalization expenses, intraoperative bleeding volume, postoperative length of hospital stay, success rate of operation, stone clearance rate, hemoglobin(Hb) level, and complications were compared among the three groups.Results The operation time, hospitalization cost of patients in group A were(72.36±18.57) min,(1.08±0.33)×10 thousand yuan, which were significantly longer or higher than(59.65±16.51) min,(1.01±0.29)×10 thousand yuan in group B and(52.37 ± 13.76) min,(0.88 ± 0.27) × 10 thousand yuan in group C. The intraoperative blood loss, postoperative length of hospital stay were(43.51±14.37) m L and(3.51±0.86) d in group A, which were significantly less or shorter than(58.13±15.24) mL,(4.35±1.14) d in group B and(60.66±16.45) mL,(3.93±1.52) d in group C(P<0.05), but there was no significant difference between group B and group C(P>0.05). After treatment, the surgical success rates of patients in group A and group B were 96.88% and 93.94%, which were significantly higher than 78.79% in group C(P<0.05). The stone clearance rates of patients in group A and group B were 93.75% and 90.91%, which were significantly higher than 75.76% in group C(P<0.05). There was no significant difference in surgical success rate and stone removal rate between group A and group B(P>0.05). After treatment, there was no significant difference in H

关 键 词：复杂性输尿管结石 后腹腔镜输尿管切开取石术 微通道经皮肾穿刺碎石取石术 经尿道输尿管镜碎石取石术 疗效 预后 

分 类 号：R693.4[医药卫生—泌尿科学]