体外震波无效的输尿管上段结石的微创手术治疗

Effect of minimally invasive surgery in treatment of upper ureteral calculi of invalid extracorporeal shock wave

目的比较微创手术治疗体外震波无效的输尿管上段结石的效果。方法研究对象为我院泌尿外科2013年1月—2015年8月体外震波无效的输尿管上段结石患者150例,均实施微创治疗,按随机数字表法将其分为MPCNL组50例、URL组50例、RLU组50例。将3组患者结石清除率、并发症发生率、手术时间和术中出血量进行对比。结果 3组术中出血量差异无统计学意义(P>0.05),分别为(57.25±4.34)m L、(53.13±4.38)m L、(57.81±4.31)m L;MPCNL组结石清除率明显高于RLU组和URL组,并发症发生率明显低于RLU组和URL组,差异有统计学意义(P<0.05),而RLU组和URL组结石清除率和并发症发生率差异无统计学意义(P>0.05);其中,URL组结石清除率、并发症发生率分别为76.00%,8.00%,MPCNL组分别为100.00%和0.00%;RLU组分别为78.00%和8.00%。手术时间比较:URL组<MPCNL组<RLU组,分别对应(36.24±12.67)min、(58.53±15.25)min、(86.24±20.67)min,组与组差异有统计学意义(P<0.05)。结论微创手术治疗体外震波无效的输尿管上段结石的效果确切,不同方法各有优缺点,其中以MPCNL结石清除率最高,URL手术时间最短,可结合患者情况选择合理术式。

Objective To evaluate the effect of minimally invasive surgery in the treatment of upper ureteral calculi of invalid extracorporeal shock wave and compare the effects of different surgical methods. Methods From January2013 to August 2015, 150 patients with upper ureteral calculi of invalid extracorporeal shock wavewere divided into a MPCNL group, URL group and RLU group（50 cases each group）, and they received the minimally invasive surgerywith different surgical methods and the effects were observed in a double blind method. The stone clearance rate, complicationincidence, operation time and blood loss were compared among the 3 groups. Results There was no significant difference among the 3 groups in the amount of bleeding（P 0.05）, and the amount of bleeding were（57.25 ＋ 4.34）m L,（53.13 ＋ 4.38）m L,（57.81 ＋ 4.31） m L in the MPCNL, URL and RLU groups respectively. The stone clearance rate of the MPCNL group was significantly higher than that of the RLU group and URL group; the complication rate of the MPCNL group was significantly lower than that of the URL and RLU groups（P 0.05）.There was no significant difference between the RLU group and URL group in the stone clearance rate and complication rate（P 0.05）.The stone clearance rate and complication rate were 76.00% and 8.00% in the URL group;100.00% and 0.00% in the MPCNL group; 78.00% and 8.00% in the RLU group, respectively. The operation time was（36.24 ＋ 12.67）min in the URL group,（58.53 ＋ 15.25）min in the RLU group,and（86.24 ＋ 20.67）min in the MPCNL group, and there was a significant difference among the 3 groups（P 0.05）.Conclusion The effect of minimally invasive surgery in the treatment of upper ureteral calculi of invalid extracorporeal shock wave is definitive. The different surgical methods havetheir advantages and disadvantages respectively.The stone clearance rate is the highest in the MPCNL group and the operation time isthe shortest in the URL group.