腹腔镜输尿管切开取石术治疗输尿管上段结石的效果评价

Evaluation of laparoscopic ureterolithotomy for treatment of upper ureteral calculi

目的分析评价腹腔镜输尿管切开取石术治疗输尿管上段结石的临床效果。方法回顾2013年1月~2018年12月于北京大学深圳医院泌尿外科手术治疗输尿管上段结石的病例,以腹腔镜输尿管切开取石术(LUL)为研究组,共计121例,以输尿管镜碎石取石术(USL)为对照组,共计152例,比较两组之间结石清除率、手术并发症等临床指标。结果 LUL组结石清除率显著高于USL组(97.5%vs 84.2%,P<0.001),并发症发生率低于USL组(8.3%vs 18.4%,P=0.012),但LUL组术中出血量更多(P<0.001)、手术时间更长(P<0.001)、术后住院时间更长(P<0.001)。结论 LUL在治疗输尿管上段结石时结石清除率更高,手术并发症更少,但手术创伤更大,手术时间更长,术后住院时间更长,且对技术要求更高,术者应根据疾病特点、病人意愿和自身技术情况合理选择治疗方案。

Objective To evaluate the clinical value of laparoscopic ureterolithotomy for upper ureteral calculi. Methods All the surgical-treated upper ureteral calculi cases from January 2013 to December 2018 in Peking University Shenzhen hospital were reviewed. The 121 laparoscopic ureterolithotomy(LUL)cases were divided into the study group,while 152 ureteroscopic lithotripsy(USL)cases were in the control group. Then we compared the stone-free rate,surgical complications and some other clinical data between the two groups. Results The LUL group had a higher stone-free rate(97.5% vs84.2%,P<0.001)and a lower surgical complication rate(8.3% vs 18.4%,P=0.012)than the USL group.However,the LUL cases had more intraoperative bleeding(P<0.001),longer operation time(P<0.001)and longer postoperative hospitalization time(P<0.001). Conclusion For the surgical treatment of upper ureteral calculi,laparoscopic ureterolithotomy provides higher stone-free rate and leads to less surgical complications,but has more intraoperative bleeding,longer operation time and longer postoperative hospitalization time,and demands higher technical level. A surgeon should choose the appropriate way of operation according to his technical condition,feature of the case and patient′s requests.