逆行置管联合200 μm激光光纤行URL与PCNL处理输尿管上段结石的疗效比较  

Comparison of retrograde catheterization combined with 200μm laser fiber URL and PCNL in the treatment of upper ureteral calculi

作　　者：吴春风 卢国汉[1] 姚汝贺[1] 陈文杰 Wu Chunfeng;Lu Guohan;Yao Ruhe;Chen Wenjie(Department of Urology,Xinrongqi Hospital,Foshan 528300,China)

机构地区：[1]广东顺德新容奇医院泌尿外科,佛山528300

出　　处：《国际泌尿系统杂志》2024年第1期59-64,共6页International Journal of Urology and Nephrology

基　　金：佛山市科技创新项目(2220001005693)。

摘　　要：目的探讨比较逆行置管联合200 μm激光光纤行输尿管镜碎石术(URL)与经皮肾镜取石术(PCNL)治疗输尿管上段结石的临床疗效。方法回顾性分析2020年7月至2022年1月本院收治的180例输尿管上段结石患者的临床资料, 结石位于骶髂关节上缘至第四腰椎(L4)椎体横突水平之间, 结石长径1.0~2.0 cm。按不同手术方式分为两组, 其中采用F6.0/7.5输尿管镜内置3F输尿管导管逆行置管联合200 μm激光光纤行URL治疗的患者81例(URL组), 采用F18通道行PCNL治疗的患者99例(PCNL组)。分别记录并比较两组患者的术前一般资料、手术时间、术中视野满意度、结石清除率、梗阻解除后肾盂压、围手术期脓毒血症发生率、住院时间、住院总费用、术前及术后的血红蛋白、血肌酐水平和输尿管支架取除后3个月随访的术侧肾脏积水情况。结果两组患者的手术时间[(52.14±15.67)min vs.(38.59±9.34)min, P=0.018]、住院时间[(8.65±2.21) d vs.(4.14±1.04)d, P=0.003]比较, 差异均有统计学意义(均P<0.05);两组患者的手术视野满意度、结石清除率比较, 差异均无统计学意义(P=0.672、0.232);同URL组相比, PCNL组的梗阻解除即刻肾盂内压力较高(P=0.043)、术后发生脓毒血症概率较高(P=0.004);PCNL组的住院总费用高于URL组(P=0.032);两组患者术前及术后的血红蛋白(P=0.376、0.385)、血肌酐(P=0.486、0.347)水平比较, 差异均无统计学意义;输尿管支架取除3个月后PCNL组的输尿管狭窄发生率高于URL组(P=0.013)。结论逆行置管联合200 μm激光光纤行URL与F18通道PCNL在治疗骶髂关节上缘至L4椎体横突水平、长径1.0~2.0 cm的输尿管结石上, 均为安全、有效的手术方式。同F18通道PCNL相比, F6.0/7.5输尿管镜内置3F输尿管导管行URL具有手术时间短、经济适用、创伤小的特点, 值得在临床推广应用。Objective To compare the clinical efficacy of retrograde catheterization combined with 200μm laser fiber for ureteroscopic lithotripsis(URL)and percutaneous nephrolithotomy(PCNL)in the treatment of upper ureteral calculi.Methods A retrospective analysis was performed on 180 patients with upper ureteral calculi admitted to our hospital from July 2020 to January 2022.The calculi were located between the upper margin of the sacroiliac joint and the transverse process level of the lumbar 4(L4)vertebra,with a diameter of 1.0-2.0 cm.All patients were divided into two groups by surgical methods.Among the all patients,81 patients were treated with F6.0/7.5 ureteroscopy with 3F ureteral catheter lithotripsis(URL group),and 99 patients were treated with F18 channel PCNL(PCNL group).Preoperative general data of two groups were recorded.Operative time,intraoperative visual field satisfaction,stone clearance rate,renal pelvis pressure after obstruction relief,perioperative sepsis incidence,length of hospital stay and total hospitalization cost were recorded in two groups.Hemoglobin and creatinine indexes were recorded before and after operation in two groups.Three months after ureteral stent removal,the intraoperative hydronephrosis was followed up.Results There was no statistical difference in preoperative general data between the two groups(P>0.05).Operation time[(52.14±15.67)min vs.(38.59±9.34)min,P=0.018]and hospital stay[(8.65±2.21)d vs.(4.14±1.04)d,P=0.003]were longer in PCNL group than in URL group,and the difference was statistically significant.There were no significant differences in surgical field satisfaction and stone clearance rate between the two groups(P=0.672,0.232).Compared with the URL group,the PCNL group had higher immediate pressure(P=0.043)and higher incidence of postoperative sepsis(P=0.004),with statistically significant differences.Total hospitalization cost in PCNL group was significantly higher than that in URL group(P=0.032).There was no significant differencein hemoglobin(P=0.376,0.385)and c

关 键 词：输尿管结石 输尿管软镜碎石术 经皮肾镜取石术 逆行置管 

分 类 号：R699.4[医药卫生—泌尿科学]