后腹腔镜肾盂切开取石术对肾盂单发结石的疗效及安全性分析

Clinical efficacy and safety of retroperitoneal laparoscopic pyelolithotomy in patients with solitary renal pelvic stone

目的探讨后腹腔镜肾盂切开取石术(RLP)在治疗肾盂单发结石患者中的疗效及安全性。方法选择2015年7月-2017年7月在该院接受治疗的肾盂单发结石患者88例,按照不同的治疗方式分为RLP组46例和经皮肾镜碎石取石术(PCNL)组42例,比较两组手术相关指标、临床疗效、肾功能指标以及术后并发症情况。结果两组手术时间、术后镇痛时间和结石清除率比较,差异均无统计学意义(P>0.05)。RLP组术中出血量、术后住院时间和术后血红蛋白降低值均明显低于PCNL组(P <0.05)。RLP组总有效率为86.96%,PCNL组总有效率为69.05%,两组比较,差异有统计学意义(P <0.05)。RLP组术后内生肌酐清除率(Ccr)、血尿素氮(BUN)和24 h尿蛋白定量水平较术前无明显变化(P>0.05),PCNL组术后Ccr水平较术前明显降低(P <0.05),且PCNL组Ccr水平明显低于RLP组(P <0.05);PCNL组术后BUN和24h尿蛋白定量水平较术前明显升高(P <0.05),且PCNL组BUN水平明显高于RLP组(P <0.05)。两组术后24 h尿蛋白定量比较无显著差异(P>0.05),两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论 RLP应用于肾盂单发结石患者中,具有疗效好、创伤小、对肾功能损伤小和并发症少的优点,可作为治疗肾盂单发结石的有效方法。

Objective To investigate the efficacy and safety of retroperitoneal laparoscopic pyeloneostomy (RLP) in treatment of solitary renal pelvic stone. Methods 88 patients with unilateral pyeloneal calculi treated from July 2015 to July 2017 were selected, these patients were divided into RLP group with 46 cases and percutaneous nephrolithotomy group (PCNL) with 42 cases according to different treatment methods. The operative indicators, clinical efficacy, renal function and postoperative complications were compared between the two groups. Results There was no statistically significant difference in the operation time, postoperative analgesic time and stone-free rate between the two groups (P > 0.05), the intraoperative blood loss, postoperative length of stay and postoperative hemoglobin reduction in RLP group were significantly lower than those in the PCNL group (P < 0.05). The total effective rate was 86.96% in RLP group and 69.05% in PCNL group, the difference between the two groups was statistically significant (P < 0.05). Comparison of clinical indexes before and after surgery was made, there were no significant different in the levels of endogenous creatinine clearance rate (Ccr), blood urea nitrogen (BUN) and 24 h urine protein quantitation in RLP group (P > 0.05). Comparison of after surgery and before surgery, there was significantly lower in Ccr level in PCNL group (P < 0.05), and Ccr level in PCNL group was significantly lower than RLP group (P < 0.05). After surgery, the levels of BUN and 24 h urinary protein in PCNL group were significantly higher than before surgery (P < 0.05), and BUN levels in the PCNL group were significantly higher than RLP group (P < 0.05), There was no significant difference in 24 h urinary protein content between the two groups after surgery (P > 0.05). There was no significant difference in complications incidence postoperative between the two groups (P > 0.05). Conclusion RLP has the advantages of good curative effect, less trauma, less damage to renal function and less complications in patients with solitary renal pelvic stone, it can be used as an effective method to treat solitary renal pelvic stone.