输尿管硬镜碎石术、后腹腔镜输尿管切开取石术、 微创经皮肾镜取石术治疗输尿管上段结石的疗效及安全性分析  

Efficacy and safety of ureteroscopic lithotripsy,retroperitoneal laparoscopic ureterolithotomy and minimally invasive percutaneous nephrolithotomy in the treatment of upper ureteral calculi.

作　　者：王磊[1] 罗子靖[1] 张爱民[1] 高景宇[1] 徐哲 郝晓东 尹海军[1] WANG Lei;LUO Zi-jing;ZHANG Ai-min(Department of Urology,the First Hospital of Hebei Medical University,Shijiazhuang Hebei 050031,China.)

机构地区：[1]河北医科大学第一医院泌尿外科,河北石家庄050031

出　　处：《临床和实验医学杂志》2021年第4期401-404,共4页Journal of Clinical and Experimental Medicine

基　　金：河北省重点研发计划项目(编号:162777220)。

摘　　要：目的探讨输尿管硬镜碎石术、后腹腔镜输尿管切开取石术、微创经皮肾镜取石术治疗复杂性输尿管上段结石的疗效及安全性。方法回顾性分析2018年7月至2020年1月在河北医科大学第一医院接受微创手术治疗的复杂性输尿管上段结石患者146例,根据手术方式不同分为输尿管硬镜碎石术(URL)组49例、后腹腔镜输尿管切开取石术(RLU)组46例、微创经皮肾镜取石术(mPCNL)组51例。比较3组患者的手术相关指标(手术时间、术中出血量、术中输血率),术后1、3 d疼痛程度,术后1、4周结石清除率及术后并发症(感染发热、输尿管损伤、尿漏)发生率的差异。结果3组患者的手术时间、术中出血量比较,差异具有统计学意义(P<0.05),URL组、mPCNL组、RLU组的手术时间分别为(39.62±5.20)、(49.35±6.74)、(60.77±8.15)min,3组呈依次延长趋势;URL组、RLU组、mPCNL组的术中出血量分别为(9.50±1.24)、(20.87±3.45)、(31.56±5.48)mL,3组呈依次增加趋势。3组患者的术后1、3 d视觉模拟评分(VAS)比较[术后1 d:(6.48±0.71)分vs.(6.39±0.68)分vs.(6.20±0.75)分;术后3 d:(2.04±0.31)分vs.(1.95±0.28)分vs.(2.11±0.32)分],差异无统计学意义(P>0.05)。RLU组、mPCNL组术后1、4周的结石清除率分别为100%、100%和92.16%、96.08%,高于URL组(71.43%、87.76%),RLU组、mPCNL组间结石清除率比较,差异无统计学意义(P>0.05)。3组患者的感染发热(14.29%vs.8.70%vs.5.88%)、输尿管损伤(10.20%vs.6.52%vs.3.92%)、尿漏(6.12%vs.2.17%vs.3.92%)等术后并发症发生率比较,差异无统计学意义(P>0.05)。结论URL、RLU、mPCNL治疗复杂性输尿管上段结石各有其优劣性,在临床应用时应综合考虑患者自身情况、术者技术水平等因素,选择最适方案。Objective To evaluate the efficacy and safety of ureteroscopic lithotripsy(URL),retroperitoneal laparoscopic ureterolithotomy(RLU)and minimally invasive percutaneous nephrolithotomy(mPCNL)in the treatment of complex upper ureteral calculi.Methods A tatol of 146 cases of complex upper ureteral calculi patients in the First Hospital of Hebei Medical University during July 2018 to January 2020 were chosen as research subject,treatment methods were retrospectively analyzed and all patients were divided into ureteroscopic lithotripsy(URL)group(n=49),retroperitoneal laparoscopic ureterolithotomy(RLU)group(n=46)and minimally invasive percutaneous nephrolithotomy(mPCNL)group(n=51).The operation related indexes(operation time,intraoperative bleeding volume,intraoperative blood transfusion rate),pain at 1 day and 3 days after operation,stone clearance rate at 1 week and 4 weeks after operation and the incidence of complications(infection fever,ureteral injury,urinary leakage)were compared among three groups.Results There were significant differences in operation time and bleeding volume among three groups(P<0.05).The operation time of URL group mPCNL group,and RLU group were(39.62±5.20),(49.35±6.74),(60.77±8.15)min,respectively,they were prolonged in turn.The intraoperative blood loss in the URL group,RLU group,and mPCNL group were(9.50±1.24),(20.87±3.45),(31.56±5.48)mL,respectively,they were increased in turn(P<0.05).There was no significant difference in VAS score between three groups at 1 day and 3 days after operation[1 day:(6.48±0.71)scores vs.(6.39±0.68)scores vs.(6.20±0.75)scores;3 days:(2.04±0.31)scores vs.(1.95±0.28)scores vs.(2.11±0.32)scores](P>0.05).The stone clearance rates of RLU group(100%,100%)and mPCNL group(92.16%,96.08%)were higher than those of URL group(71.43%,87.76%)at 1 week and 4 weeks after operation(P<0.05),but there was no significant difference in stone clearance rates between RLU group and mPCNL group(P>0.05).There were no significant difference in the incidence of complications inf

关 键 词：输尿管上段结石 输尿管硬镜碎石术 后腹腔镜输尿管切开取石术 微创经皮肾镜取石术 

分 类 号：R699.4[医药卫生—泌尿科学]