不同术式对复杂性输尿管上段结石治疗效果的比较

Comparison of curative effects of different surgical treatments on complicated upper ureteral calculi

目的探讨手术治疗方案对复杂性输尿管上段结石的临床疗效及取石碎石效果。方法回顾性分析348例复杂性输尿管上段结石患者临床资料,分别从输尿管镜下气压弹道碎石术(URSL)、经皮肾穿刺取石术(PCNL)、体外冲击波碎石术(ESWL)及后腹腔镜下输尿管上段切开取石术(RLU)等4种术式患者中,各随机抽取33例,分别纳入A、B、C、D 4组,比对各组碎石时间、术程、术中失血量、总住院时间、治疗费用等围手术期指标,以及一次性手术成功率、结石清除率(SFR)、二次或多次手术率及术后相关并发症发生情况。结果 A、C组相关围手术期指标及一次性手术成功率、SFR均显著低于B、D组(P<0.05),二次或多次手术率则显著高于B、D组(P<0.05)。在术后12个月的随访中,B组不良反应发生率为48.5%,显著高于其他3组(P<0.05)。结论 URSL术程短、创伤小,但一次性手术成功率及SFR较低;PCNL治疗SFR理想,但术后发生并发症风险高;ESWL治疗费用低、创伤小、无需术后住院,但一次性手术成功率及SFR较低;RLU一次性手术成功率及SFR极高,且术后发生并发症风险低,但手术误伤概率较大。临床需综合考虑实际情况选择最佳术式。

Objective To explore the curative effects of different surgical treatments on complicated upper ureteral calculi and the effects of lithotripsy. Methods Retrospective analysis was made on the clinical data on 348 patients with complicated upper ureteral calculi. From the patients who were treated respectively with ureteroscopic pneumatic lithotripsy（URSL）, percutaneous nephrolithotomy（PCNL）, extracorporeal shock wave lithotripsy（ESWL）, and retroperitoneal laparoscopic ureterolithotomy（RLU）, 33 ones were selected randomly and divided into groups A, B, C, and D. The time and process of lithotripsy, the intraoperative blood loss, the hospitalization time, the cost of treatment and other perioperative indicators, the success rate of one-time operation, the stone free rate（SFR）, the rate of two-or multi-time operations, and related postoperative complications among the groups were compared.Results The perioperative indicators, the success rate of one-time operation, and SFR in groups A and C were significantly lower than those in groups B and D group（P〈0.05）. During the follow-up visit of 12 months, the incidence of adverse reactions in group B was 48.5%, significantly higher than that in the other three groups（P〈0.05）. Conclusion URSL has a shorter operation duration and less trauma, but the success rate of one-time operation and the SFR are low; the SFR of PCNL is ideal, but the risk of postoperative complications is high; ESWL needs lower cost and has small trauma, and needs no postoperative hospitalization, but the success rate of one-time operation and the SFR are lower; RLU has high success rate of one-time operation and SFR, as well as low risk of postoperative complications, but the probability of accidental injury during operation is high. Therefore, it is necessary to select the best surgical treatment in clinical use according to the actual situation.