不同微创手术方法治疗输尿管上段嵌顿性结石的疗效对比

Effects of Different Minimally Invasive Operation for Patients with Impacted Upper Ureteric Calculi

目的对比3种微创术式治疗输尿管上段嵌顿性结石的临床疗效,为临床手术方式的选择提供理论依据。方法选取我院收治的141例输尿管上段嵌顿性结石患者,采用随机数字表法将其随机分为A、B、C 3组,每组各47例。A组患者接受经尿道输尿管镜碎石术(URSL),B组患者接受微创经皮肾穿刺取石术(MPCNL),C组患者接受后腹腔镜输尿管切开取石术(RLU)。对比3组患者的手术时间、术后住院天数、术后体外冲击波碎石治疗情况、术后结石清除率以及并发症的发生情况等。结果 A组的手术时间为(51.59±17.13)min,显著短于C组(P<0.05);A组的术后住院天数为(5.62±1.17)d,显著长于C组而短于B组(P<0.05);A组有36.17%的患者术后需要接受体外冲击波碎石治疗,显著高于B组和C组(P<0.05);A组术后3 d和1个月的结石清除率分别为51.06%和82.98%,均显著低于B组和C组(P<0.05)。A组术后并发症的发生率为14.89%,B组术后并发症的发生率为8.51%,C组术后并发症的发生率为6.38%;3组患者术后并发症发生率的差异没有统计学意义(P>0.05)。结论对于结石位置较低、体积较小,可采用URSL进行治疗;结石靠近肾盏或者合并有重度肾积水的患者,可采用MPCNL进行治疗;对于穿刺风险大或者URSL、MPCNL治疗失败的患者,可采用RLU进行治疗。

Objective To compare the clinical efficacy of three kinds of minimally invasive operation in the treatment of impacted upper ureteric calculi,and provide a theoretical basis for the clinical operation mode selection. Methods 141 patients with impacted upper ureteric calculi treated in the hospital were selected and randomly divided into A,B,C groups with 47 cases in each group. Patients in group A were treated with transurethral ureteroscopic lithotripsy（ URSL）. Patients in group B were treated with minimally invasive percutaneous nephrolithotomy（ MPCNL）. Patients in group C were treated with retroperitoneal laparoscopic ureterolithotomy（ RLU）. The operation time,hospitalization days,situation of extracorporeal shock wave lithotripsy（ ESWL） treatment after operation,stone clearance rate and incidence of adverse reaction of the three groups were compared. Results The operation time of group A was（ 51. 59 ± 17. 13） min,which was significantly shorter than group C（ P〈0. 05）. The hospitalization days of group A was（ 5. 62 ± 1. 17） d,which was significantly longer than group C and significantly shorter than group B（ P〈0. 05）. 36. 17% cases in group A were given ESWL,which was significantly higher than that of group B and C（ P〈0. 05）. The stone clearance rate 3 days and 1 month after the operation of group A were 51. 06%and 82. 98%,which were significantly lower than group B and C（ P〈0. 05）. The incidences of adverse reaction of the three groups were14. 89%,8. 51% and 6. 38%. The differences in the incidence of adverse reaction of the three groups were not statistically significant（ P〈0. 05）. Conclusion URSL can be used if the stone position is low and volume is small. If the stones near the calyx or complicated with severe hydronephrosis,MPCNL can be considered. RLU can be used when URSL and MPCNL treatment fails.