探讨后腹腔镜下输尿管切开取石术与经尿道输尿管软镜钬激光碎石术在治疗嵌顿性输尿管上段结石的疗效和并发症比较  

Comparison of the Efficacy and Complications of Posterior Laparoscopic Ureterotomy and Lithotripsy with Transurethral Ureteral Flexible Hol⁃mium Laser Lithotripsy in the Treatment of Embedded Upper Ureteral Stones

作　　者：陈克明[1] CHEN Keming(Department of Urology,Jinan Third People's Hospital,Jinan,Shandong Province,250132 China)

机构地区：[1]济南市第三人民医院泌尿外科,山东济南250132

出　　处：《中外医疗》2024年第7期27-30,共4页China & Foreign Medical Treatment

摘　　要：目的研究嵌顿性输尿管上段结石经后腹腔镜下输尿管切开取石术与经尿道输尿管软镜钬激光碎石术的临床价值。方法随机选取2021年8月-2023年8月济南市第三人民医院泌尿外科治疗的60例嵌顿性输尿管上段结石患者为研究对象,根据不同的治疗方式分成软镜组与腹腔镜组,各30例。软镜组患者行输尿管软镜下钬激光碎石术,腹腔镜组行经后腹腔镜下输尿管切开取石术。比较两组患者的术后发热、结石清除以及并发症发生情况,比较两组患者手术相关指标,包括手术时间、术后疼痛评分、住院时间。结果两组术后发热、结石清除以及并发症发生情况对比,差异无统计学意义(P均>0.05);软镜组手术时间(57.23±10.34)min、住院时间(4.10±0.54)d、术后疼痛评分(2.21±0.43)分均优于腹腔镜组,差异有统计学意义(t=6.879、9.195、8.181,P均<0.05)。结论后腹腔镜下输尿管切开取石术在清除结石方面可能更有效。然而,其伴随着较大的手术创伤和较多的术后疼痛。相比之下,经尿道输尿管软镜钬激光碎石术具有更加明显的优势,可以减轻术后的疼痛,并降低手术和住院的时间,在选择治疗方法时应根据具体情况进行权衡。Objective To study the clinical value of holmium laser lithotripsy for embedded upper ureteral stones via posterior laparoscopic ureterotomy and transurethral ureteral flexible lens.Methods A total of 60 patients with embed-ded upper ureteral stones treated in the Department of Urology of Jinan Third People's Hospital from August 2021 to August 2023 were randomly selected as the study objects,and they were divided into the flexible lens group and the laparoscopic group according to different treatment,with 30 cases in each group.The flexible lens group received hol-mium laser lithotripsy under flexible ureteroscopy,and the laparoscopic group was treated with posterior laparoscopic ureterotomy and lithotripsy.The occurrence of postoperative fever,stone removal,and complications were compared between the two groups,and the surgery-related indexes of the two groups were compared,including operation time,postoperative pain score,and hospitalization time.Results There was no statistically significant difference in the occur-rence of postoperative fever,stone removal,and complications between the two groups(all P>0.05).The operation time(57.23±10.34)min,hospitalization time(4.10±0.54)d,and postoperative pain score(2.21±0.43)points in the flexible lens group were better than those in the laparoscopic group,the differences were statistically significant(t=6.879,9.195,8.181,all P<0.05).Conclusion Posterior laparoscopic ureterotomy and lithotripsy may be more effective in re-moving stones.However,it is accompanied by greater surgical trauma and more postoperative pain.In contrast,trans-urethral ureteral flexible holmium laser lithotripsy has more obvious advantages,it can reduce postoperative pain and decrease the duration of surgery and hospitalization,which should be weighed on a case-by-case basis when choosing a treatment.

关 键 词：输尿管 结石 并发症 疗效 手术时间 住院时间 

分 类 号：R714.258[医药卫生—妇产科学]