不同微创手术治疗复杂性输尿管上段结石的疗效对比  

Comparison of Efficacy of Different Minimally Invasive Surgery in the Treatment of Complex Upper Ureteral Calculi

作　　者：戴勇 黄志鹏 喻海鹏 娄宇灵 米其武[2] DAI Yong;HUANG Zhipeng;YU Haipeng;LOU Yuling;MI Qiwu(Department of Urology,Dongguan Hospital of Integrated Traditional Chinese and Western Medicine,Dongguan Guangdong 523000,China;Department of Urology,Dongguan People’s Hospital,Dongguan Guangdong 523000,China)

机构地区：[1]东莞市中西医结合医院泌尿外科,广东东莞523000 [2]东莞市人民医院泌尿外科,广东东莞523000

出　　处：《中国卫生标准管理》2022年第11期39-41,共3页China Health Standard Management

摘　　要：目的对比经尿道输尿管硬镜下钬激光碎石术(transurethral hard ureteral holmium laser lithotripsy,URL)、经尿道输尿管软镜下钬激光碎石术(transurethral soft ureteral holmium laser lithotripsy,FURS)、经皮肾镜钬激光碎石取石术(percutaneous nephroscope holmium laser lithotripsy,PCNL)治疗复杂性输尿管上段结石的临床效果及手术指标。方法研究对象为2019年2月—2021年3月在东莞市中西医结合医院进行微创手术治疗的90例复杂性输尿管上段结石患者,回顾性分析其手术资料,将30例采用URL治疗的患者纳入URL组,将采用FURS治疗的30例患者纳入FURS组,将采用PCNL治疗的30例患者纳入PCNL组。比较三组各时间段(术后7 d、1个月)的结石清除率及手术指标水平[手术用时、术中出血量、术后视觉模拟评分法(visual analogue scale,VAS)评分]。结果术后7 d,URL组结石清除率低于PCNL组,但受到样本量影响组间差异无统计学意义(P>0.05);PCNL组结石清除率与FURS组相比较低,差异有统计学意义(P<0.05)。术后1个月,URL组结石清除率与PCNL组、FURS组相比较低,差异有统计学意义(P<0.05);PCNL组与FURS组术后1个月结石清除率差异无统计学意义(P>0.05)。FURS组手术用时与URL组、PCNL组相比较长;PCNL组的术中出血量与URL组、FURS组相比较大;PCNL组术后VAS评分为高于URL组、FURS组,差异有统计学意义(P<0.05)。结论与URL相比,FURS或PCNL在清除复杂性输尿管上段结石方面的效果较为显著;与PCNL、URL相比,FURS手术耗时较长;FURS、URL治疗的术后出血风险较低,术后疼痛程度较低。Objective To compare the clinical effects and surgical indexes of transurethral hard ureteral holmium laser lithotripsy(URL),transurethral soft ureteral holmium laser lithotripsy(FURS)and percutaneous nephroscope holmium laser lithotripsy(PCNL)in the treatment of complex upper ureteral calculi.Methods A total of 90 patients with complex upper ureteral calculi who received minimally invasive surgical treatment in Dongguan Hospital of Integrated Traditional Chinese and Western Medicine from February 2019 to March 2021 were retrospectively analyzed.Thirty patients treated with URL were included in the URL group,and 30 patients treated with FURS were included in the FURS group.Thirty patients treated with PCNL were included in the PCNL group.The stone clearance rate(postoperative 7 d,postoperative 1 month)and the level of surgical indicators[operative time,intraoperative blood loss,postoperative visual analogue scale(VAS)score]were compared among the three groups at each time period.Results At 7 days after operation,the stone clearance rate of URL group was lower than that of PCNL group,but there was no statistical significance between the two groups affected by sample size(P>0.05).The stone clearance rate of PCNL group was lower than that of FURS group,the difference was statistically significant(P<0.05).One month after operation,the stone clearance rate of the URL group was lower than that of the PCNL group and the FURS group,the difference was statistically significant(P<0.05).There was no significant difference in stone clearance rate between PCNL group and FURS group 1 month after operation(P>0.05).The operation time of FURS group was longer than that of URL group and PCNL group.The amount of intraoperative blood loss in PCNL group was larger than that in URL group and FURS group.The postoperative VAS score of PCNL group was higher than that of URL group and FURS group,the difference was statistically significant(P<0.05).Conclusion Compared with URL,FURS or PCNL is more effective in removing complex upper ureter

关 键 词：经尿道输尿管硬镜下钬激光碎石术 经尿道输尿管软镜下钬激光碎石术 经皮肾镜钬激光碎石取石术 复杂性输尿管上段结石 结石清除率 手术风险 

分 类 号：R693[医药卫生—泌尿科学]