3种微创术式治疗输尿管上段嵌顿结石的临床疗效比较  

Comparison of three minimally invasive methods in treatment of upper ureteral incarcerated calculi

作　　者：宋立杰[1] 李梦旭 魏红建[1] 马龙 马芳 SONG Lijie;LI Mengxu;WEI Hongjian;MA Long;MA Fang(Second Department of Urology,Baoding First Central Hospital,Baoding Hebei 071000,China;Department of Otolaryngology,Xinle Hospital of Traditional Chinese Medicine,Shijiazhuang 050799,China)

机构地区：[1]保定市第一中心医院泌尿二科,河北保定071000 [2]新乐市中医医院耳鼻喉科,石家庄050799

出　　处：《新疆医科大学学报》2022年第5期511-515,共5页Journal of Xinjiang Medical University

基　　金：河北省中医药管理局项目(2018303);保定市科技局科技攻关计划项目(16ZF010)。

摘　　要：目的对比后腹腔镜输尿管上段切开取石术(Retroperitoneal laparoscopic upper ureterolithotomy,RLU)、无管化微创经皮肾镜取石术(Tubeless minimally invasive percutaneous nephrolithotomy,mPCNL)与输尿管软镜碎石取石术(Ureteroscopic lithotripsy,FURL)治疗输尿管上段嵌顿结石的临床疗效。方法选取2019年1月—2020年10月保定市第一中心医院泌尿二科收治的181例输尿管上段嵌顿结石患者为研究对象,采用随机数字表法分为mPCNL组(n=61)与RLU组(n=60)、FURL组(n=60)。mPCNL组采取mPCNL,RLU组采取RLU,FURL组采取FURL,对比3组手术情况(手术时间、一次性结石清除率、术后7 d及30 d净石率、术中失血量、术后血尿时间、住院时间)、术前及术后即刻、术后7 d前列腺素F2α(PGF2α)、前列腺素E2(PGE2)、角细胞生长因子(KGF)水平、并发症发生率。结果与RLU组比较,mPCNL组、FURL组手术时间缩短,与FURL组比较,mPCNL组、RLU组一次性结石清除率、术后7 d及30 d净石率增高,与mPCNL组、FURL组比较,RLU组术中失血量减少,与RLU组、FURL组比较,mPCNL组术后血尿时间、住院时间缩短,差异有统计学意义(P<0.05)。与术前比较,术后即刻3组血清PGF2α、PGE2及KGF水平增高(P<0.05);与术后即刻比较,术后7 d 3组血清PGF2α、PGE2及KGF水平降低(P<0.05),术后不同时间段mPCNL组、FURL组血清PGF2α、PGE2及KGF水平低于RLU组,差异有统计学意义(P<0.05)。与RLU组(16.67%)比较,mPCNL组并发症发生率(4.92%)与FURL组发生率(5.00%)降低,差异有统计学意义(P<0.05)。结论mPCNL、RLU及FURL对输尿管上段嵌顿结石均有良好的治疗效果,其中mPCNL及RLU结石清除率较高,mPCNL、FURL可减少手术创伤,降低手术创伤所致的疼痛应激及并发症发生率。Objective To compare the clinical efficacy of retroperitoneal laparoscopic upper ureterolithotomy(RLU),tubeless minimally invasive percutaneous nephrolithotomy(MPCNL)and ureteroscopic lithotripsy(furl)in the treatment of upper ureteral incarcerated calculi.Methods 181 patients with upper ureteral incarcerated stones were treated in the hospital from January 2019 to October 2020 were selected as the research objects.The patients were randomly divided into MPCNL group(n=61),RLU group(n=60)and furl group(n=60).The mPCNL group took mPCNL,the RLU group took RLU,and the FURL group took FURL.The operation conditions of the three groups(operation time,one-time stone clearance rate,7-day and 30-day postoperative stone clearance rate,intraoperative blood loss,postoperative hematuria time,hospitalization time),preoperative and immediate postoperative,postoperative 7 d Prostaglandin F2α(PGF2α),prostaglandin E2(PGE2),keratinocyte growth factor(KGF)levels,and incidence of complications.Results Compared with RLU group,the operation time of MPCNL group and furl group was shortened.Compared with furl group,the one-time stone clearance rate and stone clearance rate at 7 and 30 days after operation in MPCNL group and RLU group were increased.Compared with MPCNL group and furl group,the intraoperative blood loss in RLU group was reduced.Compared with RLU group and furl group,the postoperative hematuria time and hospital stay in MPCNL group were shortened,and the difference was statistically significant(P<0.05).Compared with before operation,the levels of serum PGF2α,PGE2 and KGF in the three groups were increased immediately after operation(P<0.05).The levels of serum PGF2α,PGE2 and KGF in the mPCNL group and the FURL group were lower than those in the RLU group at different time periods after the operation,and the differences were statistically significant(P<0.05).Compared with the RLU group(16.67%),the incidence of complications in the mPCNL group(4.92%)and the FURL group(5.00%)were lower,and the difference was statistically s

关 键 词：后腹腔镜输尿管上段切开取石术 无管化微创经皮肾镜取石术 输尿管软镜碎石取石术 输尿管上段嵌顿结石 

分 类 号：R615[医药卫生—外科学]