微创手术治疗体外震波无效的输尿管上段结石的疗效比较

A Comparison of Efficacy of Minimally Invasive Surgery in Treatment of Upper Ureteral Calculi Patients Failed to Respond to Extracorporeal Shockwave

目的探究体外震波治疗无效的输尿管上段结石患者采用不同微创手术治疗后的临床效果,为今后的治疗工作提供参考依据。方法选取我院2011年4月至2014年4月收治的40例经体外震波治疗无效的输尿管上段结石患者为研究对象,按照手术方式的不同分为A组(15例)、B组(15例)、C组(10例)。A组采用微创经皮输尿管镜(MPCNL)治疗、B组给予逆行输尿管镜(URL)治疗、C组给予后腹腔镜下输尿管切开取石(RLU)治疗。观察三组的治疗效果和并发症发生情况。结果 B组患者手术时间明显短于A组,A组患者手术时间明显短于C组,差异均具有统计学意义(P<0.05)。三组患者术中出血量相比差异不显著(P>0.05)。C组手术成功率和术后2月结石清除率均高于A、B两组,术后并发症低于A、B两组,但A、B两组间以上指标相比均无统计学差异(P>0.05)。结论 MPCNL与RLU相比URL对患者结石清除率较高,但采用URL的手术时间更短,所以应当根据患者的具体情况确定手术方式。

Objective To investigate the clinical effect of different minimally invasive surgery on patients with upper ureteral calculi who failed to respond to extracorporeal shockwave, and to provide reference basis for the treatment work in the future. Methods 40 patients with upper ureteral calculi who didn＇t respond to extracorporeal shockwave in our hospital from April 2011 to April 2014 were selected and divided into group A（15 cases）, group B（15 cases） and group C（10 cases） according to different treatment method. Group A was given microinvasive percutaneous nephrolithotomy with lithotomy（MPCNL）, group B was given ureteroscopelithtripsy（URL）, group C was given retroperitoneal laparoscopic ureterolithotomy（RLU）. The treatment effect and situations of complications in three groups were observed.Results The operative time of group B was significantly shorter than that of group A and C, the operative time of group A was significantly shorter than that of group C, all the difference was statistical（P〈0.05）. The bleeding volume of three groups during operation had no statistical difference（P〉0.05）. The operation success rate and 2-month-postoperative calculi clearance rate of group C were higher than those of group A and B, the complication rate was lower than that of group A and B, but the above indexes between group A and B had no statistical difference（P〉0.05）. Conclusions Compared with RLU, MPCNL and URL has high calculi clearance rate, but the operative time of URL is shorter. Therefore, the surgical method should be determined according to the specific situations of patients.