腹腔镜技术治疗上尿路结石的初步研究

Preliminary application of laparoscopic technique in treatment of upper urinary calculi

目的探求合理的处理上尿路结石的个体化治疗方案。方法 2013年1月-2016年6月,对具有一定特点的上尿路结石患者147例(侧)进行腹腔镜下取石或相应手术治疗。就Ⅰ期结石清除率、术中术后输血例数、术后介入止血例数、术后发热(≥38℃)例数、术后重症感染例数、术后狭窄、平均住院时间和平均治疗费用指标与2016年6月前的结石位置、形态、负荷分别相近、例(侧)数相当、行经皮肾镜取石术(PCNL)及输尿管镜钬激光碎石术(URSL)的147例(侧)患者的治疗结果进行比较。结果腹腔镜组Ⅰ期结石清除率100.00%(147/147),明显高于PCNL及URSL组91.84%(135/147),差异有统计学意义(P=0.001);腹腔镜组无术中术后输血(0/147)、介入止血(0/147),明显低于PCNL及URSL组的6例(6/147)和4例(4/147),差异均有统计学意义(P=0.013和P=0.044);腹腔镜组无术后重症感染发生(0/147),PCNL及URSL组发生术后重症感染2例(2/147),差异无统计学意义(P=0.156);腹腔镜组术前体温正常134例,术后发热(≥38℃)9例(9/134),明显低于PCNL及URSL组28例(28/147),差异有统计学意义(P=0.002);腹腔镜组术后尿路狭窄3例(3/114),明显低于PCNL及URSL组的9例(9/101),差异有统计学意义(P=0.045);腹腔镜组平均住院时间(10.12±0.29)d,明显低于PCNL及URSL组的(13.79±0.38)d,差异有统计学意义(P=0.011);腹腔镜组平均治疗费用(12 514.84±181.54)元,明显低于PCNL及URSL组的(18 124.65±302.32)元,差异有统计学意义(P=0.018)。结论某些情况下,当上尿路结石适合"切开取出"时,利用腹腔镜技术处理更为安全;当同时存在需要手术处理的合并症或并发症时,可同时处理。腹腔镜技术是上尿路结石微创治疗的重要方法之一。

Objective To evaluate the reasonable individual program for upper urinary tract calculi in minimally invasive treatment. Methods From January 2013 to June 2016, 147 patients （sides） with upper urinary calculi who had some characteristics received laparoscopic nehprectomy or corresponding surgical treatment. The number of cases of postoperative stagnation, the average hospitalization time and the average cost of treatment were compared with those of 147 patients （lateral） who underwent PCNL and URSL with the similarity, shape and load of stones before June 2016, respectively. Results The removal rate of stage I was 100.00% （147/147） in laparoscopic group, which was signifcantly higher than that in PCNL and URSL group （91.84%, 135/147）, the difference was statistically signifcant （P = 0.001）; Laparoscopic group postoperative blood transfusion （0/147） and interventional hemostasis （0/147） were significantly lower in 6 cases （6/147） and 4 cases （4/147） in PCNL and URSL groups,the differences were statistically significant （P = 0.013, P = 0.044）. There was no postoperative severe infection in laparoscopic group （0/147）, which has no significant difference （P = 0.156） in postoperative severe infection between PCNL and URSL group （2/147）. There were 9 cases of 134 cases of postoperative （9/134） fever at ≥ 38℃ in laparoscopic group, which was signifcantly lower than that in PCNL and URSL group （28/147）, the difference was statistically signifcant （P = 0.002）; Laparoscopic group of postoperative urinary tract stenosis in 3 cases （3/114）, which was signifcantly lower than that of PCNL and URSL group （9/101）, the difference was statistically signifcant （P = 0.045）. The average length of stay in laparoscopic group was （10.12 ± 0.29） d, which was signifcantly lower （P = 0.011） than that in PCNL and URSL group （13.97 ± 0.38） days. The average cost of treatment in laparoscopic group （12 541.84 ± 181.54） yuan was signifcantly lower than that in PCNL and URSL group （18 124.65 ± 302.32） yuan, the difference was statistically signifcant （P = 0.018）. Conclusion In some cases, when the upper urinary tract calcuci are suitable for ‘cut out’, the use of laparoscopic treatment is more secure; when there is a need for surgical treatment of complications, can be treated simultaneously. Laparoscopic technique is one of the important methods of minimally invasive treatment for upper urinary calculi.