腹腔镜手术与球囊扩张术治疗输尿管下段狭窄的效果比较

Comparison of laparoscopic and balloon dilatation in the treatment of lower ureteral stricture

目的探讨腹腔镜手术及球囊扩张术(PTCA)治疗输尿管下段狭窄的效果,为临床术式选择提供依据。方法选取2015年1月～2018年1月我院收治的35例输尿管下段狭窄患者,根据手术方式的不同分为腹腔镜组(16例)与球囊扩张组(19例)。腹腔镜组采用腹腔镜切除输尿管狭窄区段再吻合术进行治疗,球囊扩张组采用经尿道输尿管PTCA治疗,术后随访6个月,比较两组的临床治疗效果、手术时间、术中出血量、术后住院时间及并发症发生情况。结果两组的临床治疗效果、术后并发症总发生率比较,差异无统计学意义(P<0.05)。腹腔镜组的手术时间与住院时间长于球囊扩张组(P<0.05),术中出血量多于球囊扩张组(P<0.05),再次狭窄率0.00%,低于球囊扩张组的26.32%,差异有统计学意义(P<0.05)。结论腹腔镜手术与PTCA在输尿管下段狭窄的治疗的效果与安全性基本相当,对于输尿管狭窄区段1.0 cm及以下者,推荐选择PTCA治疗;对于输尿管狭窄区段1.0 cm以上者,推荐选择腹腔镜手术治疗。

Objective To evaluate the efficacy of laparoscopic surgery and balloon dilatation in the treatment of lower ureteral stenosis, to provide guidance for the selection of clinical operation methods. Methods From January 2015 to January 2018, 35 patients with lower ureteral stenosis in our hospital were selected and divided into laparoscopic group (n=16) and balloon dilatation group (n=19) according to different surgical methods. The patients in the laparoscopic group were treated by laparoscopic resection of ureteral stricture section reanastomosis, and the patients in the balloon dilatation group were treated by transurethral ureteral balloon dilatation. All patients were followed up for 6 months after treatment. The differences in clinical treatment, operative time, intraoperative bleeding, postoperative hospital stay and complications were compared between the two groups. Results There was no significant difference in the effect of clinical treatment and the total incidence of postoperative complications between the two groups (P>0.05). The operative time and hospital stay in the laparoscopic group were longer than those in the balloon dilatation group (P<0.05), and the amount of intraoperative bleeding was more than that in the balloon dilatation group (P<0.05), the re-stenosis rate of laparoscopic group was 0.00%, significantly lower than that of balloon dilatation group (26.32%), the differences were statistically significant (P<0.05). Conclusion Laparoscopic surgery and balloon dilatation in the treatment of lower ureteral stricture is basically the same efficacy and safety. For ureteral stricture segment 1.0 cm or less, balloon dilatation is recommended for treatment. For ureteral stricture segment 1.0 cm or more, laparoscopic surgery is recommended.