腹腔镜联合胆道镜对肾盂输尿管连接部狭窄疗效观察

Observation on curative effects of laparoscopy combined with choledochoscopy on ureteropelvic junction stenosis

目的 探讨腹腔镜联合胆道镜对肾盂输尿管连接部狭窄并发肾结石的临床疗效。方法 选择2006年1月-2014年6月至我院治疗肾盂输尿管连接部狭窄并发肾结石的患者共计110例,按照治疗方案分为开放组58例与微创组52例,分别予开放术式或腹腔镜联合胆道镜治疗,比较两组手术相关指标;术后随访6个月,比较两组吻合口再狭窄及肾结石复发情况。结果 微创组手术时间、术后住院时间、拔管时间、术中出血量、术后镇痛药用量及术后胃肠道恢复时间等指标均低于开放组（P〈0.05）。6个月随诊发现,两组肾结石复发率没有显著差异（P〉0.05）,而微创组的吻合口再狭窄率低于开放组,但是差异没有统计学意义（P〉0.05）。结论 腹腹腔镜联合胆道镜治疗肾盂输尿管连接部狭窄合并肾结石,在达到与开放手术相同效果的前提下,创伤小、出血少、患者痛苦少、术后恢复快、住院时间短,值得在临床上广泛开展。

Objective To explore the curative effects of laparoscopy combined with choledochoscopy on ureteropelvic junction stenosis complicated with renal calculi. Methods 110 patients with ureteropelvic junction stenosis complicated with renal calculi who were hospitalized between January 2006 and June 2014 were selected and divided into open group （58 cases） and minimally invasive group （52 cases） according to the treatment plans. The two groups received open surgery or laparoscopy combined with choledochoscopy treatment. The correlated indexes were compared between the two groups. Postoperative follow-up had been carried out for 6 months. Comparison was made in the recurrence of stoma restenosis and kidney stones between the two groups. Results In the minimally invasive treatment group, the operative time, postoperative hospital stay, extubation time, intraoperative blood loss, the usage amount of postoperative analgesia drug, and postoperative recovery time of gastrointestinal tract were all lower than those in the open treatment group（P 〈 0.05）. The six-month follow-up found out that the difference in the recurrence of renal calculi between the two groups was not significant（P 〈 0.05）. The stoma restenosis rate in the minimally invasive treatment group was lower than that in the open treatment group, but the difference was no significant （P〉 0.05）. Conclusion Laparoscopy combined with choledochoscopy on ureteropelvic junction stenosis complicated with renal calculi can achieve the same effect as the open surgery, and at the same time, this threatment has the advantages such as less trauma, less bleeding, less pain, rapid recovery, and short hospital stay. It should be widely promoted in the clinic.