腹腔镜与开放手术行肾盂输尿管切开取石术的比较

Comparison of therapeutic effects between laparoscopic pyeloureterolithotomy and open surgery

目的比较经腹膜途径腹腔镜手术与开放手术行肾盂输尿管切开取石术的效果,并探讨腹腔镜手术的优势。方法回顾性分析28例经腹膜途径腹腔镜(A组)、56例开放手术(B组)行肾盂输尿管切开取石术患者的临床资料,对其基本资料(年龄、性别、身高、体质量、病史)、结石情况(位置、大小)、手术情况(手术时间、术中出血量)、术后并发症发生率、术后恢复情况(肠功能恢复、下床活动时间)、住院费用及住院时间等数据进行统计分析。结果 两组手术全部成功,两组患者基本资料、结石情况无明显差异,术后并发症发生率相当,A组在术中出血量、术后恢复速度、住院时间等方面占优势(P<0.05);B组在手术时间及住院费用方面占优势。结论 经腹膜途径腹腔镜肾盂输尿管切开取石术具有创伤小、出血少、恢复快的特点。手术适应证与开放手术相当,条件允许下可替代开放手术。

Objective To study therapeutic effects of abdominal laparoscopic pyeloureterolithotomy and open surgery on treating renal pyelic calculi and upper segment ureteral calculi, and evaluate the value of laparoscopy. Methods 84 patients were included in this study and all underwent pyeloureterolithotomy, 28 by abdominal laparoscopy（ group A） and 56 by open surgery（ group B）. The data of basics（ age, sex, height, weight and medical history）, stone characteristics （ size and location）, operation （ operating time and bleeding volume）, complication rate, post-operation （recovery of intestinal function and ambulation after operation）, cost of hospitalization and hospital stay time were retrospectively analyzed. Results All surgeries in groups A and B were successful. The basics, stone characteristics and complication rate showed no significant difference. Group A had less average bleeding volume in operation, quicker recovery of intestinal function and ambulation after operation, and shorter hospital stay than group B（P 〈0.05）. While group B had shorter operating time and less cost of hospitalization（ P 〈 0.05 ）. Conclusion Laparoscopic pyeloureterolithotomy has the characteristics of mini-invasion, little bleeding and quick recovery. It has the same indications as open surgery, and may replace open surgery under given conditions.