腹腔镜与开放输尿管切开取石术治疗输尿管结石的临床疗效分析

Analysis of the Clinical Therapeutic Effect of Laparoscopic Ureterolithotomy and Open Surgery on Ureteral Calculus

目的：比较腹腔镜与传统开放手术行输尿管切开取石术治疗输尿管结石的临床效果，评价腹腔镜手术的优势。方法：回顾性分析我院2011年9月-2013年2月45例行开放输尿管切开取石术（开放组）与33例行腹腔镜输尿管切开取石术（腹腔镜组）患者的临床资料并进行比较。结果：78例手术均取石成功，腹腔镜组2例分别因结石逃逸入肾盂和输尿管炎症水肿粘连明显改行开放手术。腹腔镜组在术中出血量、术后下床时间、肛门排气时间、术后引流总量、术后引流时间、住院天数方面均显著优于开放组，而手术时间及住院总费用显著高于开放组，差异均有统计学意义（P〈0．05）。两组患者术后均未出现尿瘘、伤口愈合不良、严重血尿等并发症。结论：两组术式治疗输尿管结石均能有效取石，腹腔镜术式在很多方面拥有一定优势，传统切开取石也有自己的特点。临床上应综合考虑患者意愿、病情特点、术者操作水平、患方经济条件等一系列因素决定最终手术方式。

Objective： To compare the clinical therapeutic effect of laparoscopic ureterolithotomy and traditional ureterolithotomy on ureteral calculus,and evaluate the advantages of laparoscopic surgery. Methods： The clinical data of 45 patients who underwent traditional ureterolithotomy surgery （open surgery group） were retrospectively campared with those for 33 patients who underwent laparoscopic surgery （laparoscopic group） in our hospital from September 2011 to February 2013. Results： All the surgeries were smoothly completed, two patients in laparoscopic group ended up in open surgery respectively because of calculus escape to the renal pelvic and chronic ureteritis. The bleeding volume, postoperative ambulation, anal exhaust time, postoperative drainage volume, postoperative drainage time and hospital stay in the laparoscopic group was superior to that of open surgery group, nevertheless, the laparoscopic group had longer mean surgical time and higher cost of hospitalization, a statistically significant difference. No complications such as urinary fistula, poor wound healing and severe hematuria occurred in both groups. Conclusion： These two kinds of operation were both appropriate methods, laparoscopic ureterolithotomy had certain advantages in many aspects and traditional ureterolithotomy surgery had own characteristics.We surgeons should consider the willingness of patients, disease attributes, manipulation ability, the patients economic conditions and so on, to determine the final operation method.