不同手术方式治疗移植肾输尿管上段结石的疗效及安全性分析  

Efficacy and safety of different surgical procedures for upper ureteral calculi after renal transplantation

作　　者：张李晓[1] 张栩亮[1] ZHANG Lixiao;ZHANG Xuliang(Department of Urology,Sinopharm Dongfeng General Hospital,Hubei University of Medicine,Shiyan 442008,China)

机构地区：[1]湖北医药学院附属国药东风总医院泌尿外科,湖北十堰442008

出　　处：《现代泌尿外科杂志》2022年第5期412-415,共4页Journal of Modern Urology

摘　　要：目的探讨不同手术方式治疗移植肾输尿管上段结石的疗效及安全性。方法回顾性分析2013年1月-2020年6月在湖北医药学院附属国药东风总医院移植中心接受手术治疗的移植肾输尿管上段结石患者50例的临床资料,其中20例行输尿管软镜碎石取石术为软镜组,20例行经皮肾镜碎石取石术(PCNL)为PCNL组,10例接受常规开放手术为开放组。对比分析各组的术中输血例数、手术时间和住院时间、术后的结石清除率和肾积水缓解率、血肌酐变化值以及术后1个月的疼痛及不良反应发生率。结果软镜组住院时间(5.0±0.86)d、手术时间(42.3±5.72)min均显著优于PCNL组、开放组(P<0.05);PCNL组(1例)、软镜组(0例)的输血例数均显著优于开放组(4例),差异有统计学意义(P<0.05);各组的结石清除率、肾积水缓解率、术后1 d、1个月的血肌酐变化对比差异均无统计学意义(P>0.05);在术后第5天软镜组(32.20±1.88)μmol/L的血肌酐值均显著高于术后1 d、1个月(P<0.05)。结论采用本次实验提出的3种不同手术方式均可清除输尿管上段结石,以保持泌尿系统的畅通,保护肾功能。效果最优的为输尿管软镜碎石取石术,具有住院时间短、恢复快、创伤小、不良反应发生率低等优点。Objective To investigate the efficacy and safety of different surgical methods in the treatment of upper ureteral calculi after renal transplantation.Methods The clinical data of 50 patients with transplanted upper ureteral calculi who underwent surgery at our hospital during Jan.2013 and Jun.2020 were retrospectively analyzed,including 20 cases of ureteroscopic lithotripsy in the flexible ureteroscope group,20 cases in the percutaneous nephrolithotripsy(PCNL)group,and 10 cases in conventional open surgery group.The number of cases who received intraoperative blood transfusion,operation time,hos-pital stay,stone-clearance rate,remission rate of hydronephrosis,change of creatinine,and incidence of pain and adverse reactions 1 month after operation were compared.Results The flexible ureteroscope group had significantly shorter hospitalization time(5.0±0.86)d and operation time(42.3±5.72)min than the other 2 groups(P<0.05).The PCNL group(1 case)and flexible ureteroscope group(0 case)had significantly fewer cases of blood transfusion than the open group(4 cases)(P<0.05).There were no significant differences in stone-clearance rate,remission rate of hydronephrosis,change of creatinine 1 day and 1 month after operation(P>0.05).On day 5 after operation,the creatinine was significantly higher in the flexible ureteroscope group(32.20±1.88)μmol/L than that on day 1 and month 1 after operation(P<0.05).Conclusion All three surgical methods can remove upper ureteral calculi to keep the urinary tract smooth and protect the renal function.Flexible ureteroscopic lithotripsy has the best efficacy,which has advantages of short hospital stay,fast recovery,small trauma,and low incidence of adverse reactions.

关 键 词：移植肾 结石 输尿管上段 输尿管软镜 经皮肾镜 结石清除率 

分 类 号：R699.4[医药卫生—泌尿科学]