(输尿管)软镜配合腹腔镜治疗输尿管结石(L4以上)合并肾结石的临床效果评价

Clinical Evaluation of Ureteroscope Combined with Laparoscopic Treatment of Ureteral Calculi(L4+)with Renal Calculi

目的探讨输尿管结石合并肾结石患者行软镜配合腹腔镜治疗的临床价值。方法以回顾性分析对该院于2015年7月—2016年7月期间接收的输尿管结石合并肾结石患者62例进行分析,采用随机数字表法将62例患者平均分为研究组和对照组,每组31例。对照组行常规经腰部开放手术,研究组行软镜联合腹腔镜治疗,分析两组治疗后的研究结果、两组临床指标以及并发症发生率。结果①62例患者成功完成手术,随访率100%;②研究组手术用时(125.8±25.5)h、住院用时(7.8±2.4)d、拔管用时(3.3±0.7)d、术中出血量(112.2±22.8)mL和术后胃肠道恢复用时(9.7±3.3)h优于对照组(165.7±36.2)h、(11.1±3.7)d、(5.2±1.4)d、(289.5±35.5)mL、(16.8±4.4)h,组间对比差异有统计学意义(t=4.997、4.166、6.758、23.397、7.187,P<0.05);③研究组吻合口再狭窄3例(9.7%)和肾结石复发率2例(6.4%)与对照组对比5例(16.1%)、4例(12.9%),差异无统计学意义(χ^2=0.574、0.738,P>0.05);④研究组31例中,患者术后2 d下床活动,待肛门排气后进流食,而后普食。术后保持引流管通畅,2周后拔除,术后5~7 d拔除导尿管,术后4周拔除双J管。结论将软镜联合腹腔镜应用于输尿管结石合并肾结石治疗中,能够有效缩短手术时间、术后恢复快、出血量少,具有临床推广优势。

Objective To investigate the clinical value of soft laposcopy combined with laparoscopic treatment for patients with ureteral calculi complicated with renal calculi.Methods A retrospective analysis of 62 patients with ureteral calculi complicated with renal calculi received from July 2015 to July 2016 was performed.The patients were divided into study group and control by random number table,each with 31 cases.The control group underwent routine open lumbar surgery.The study group underwent soft-lens combined with laparoscopic treatment.The results of the two groups after treatment,the clinical indicators of both groups and the incidence of complications were analyzed.Results 1.162 patients successfully completed the operation,the follow-up rate was 100%.2.The study group(125.8±25.5)h,be hospitalized time(7.8±2.4)d,extubation time(3.3±0.7)d,intraoperative bleeding amount(112.2±22.8)mL and postoperative gastrointestinal recovery time(9.7±3.3)h were better than the control group(165.7±36.2)h,(11.1±3.7)d,(5.2±1.4)d,(289.5±35.5)mL,(16.8±4.4)h,the comparison between groups was statistically significant(t=4.997,4.166,6.758,23.397,7.187,P<0.05);3.study group anastomotic restenosis 3 cases(9.7%)and renal stone recurrence rate of 2 cases(6.4%)compared with the control group 5 cases(16.1%),4 cases(12.9%),no statistical significance(χ^2=0.574,0.738,P>0.05);4.of the study group of 31 cases,the patients got out of bed 2 d after the operation,and after the anus was exhausted,the food was fed,and then the food was eaten.The drainage tube was kept unobstructed after operation,and was removed after 2 weeks.The catheter was removed 5-7 d after surgery,and the double J tube was removed 4 weeks after operation.Conclusion Soft laparoscopic combined with laparoscopy in the treatment of ureteral calculi combined with kidney stones can effectively shorten the operation time,quick recovery and less bleeding,and has clinical advantages.