腹腔镜输尿管镜双镜联合技术与输尿管成形术治疗输尿管狭窄的疗效及安全性

Comparison of the efficacy and safety of laparoscopic ureteroscopy combined with ureteroplasty for ureteral stricture

目的对比腹腔镜输尿管镜双镜联合技术与输尿管成形术治疗输尿管狭窄的有效性及安全性。方法研究对象选取2015年6月至2018年12月期间我院收治的输尿管狭窄患者85例,随机分为双镜组45例、对照组40例。双镜组患者实施腹腔镜输尿管镜双镜联合技术治疗,对照组患者实施输尿管成形术治疗。比较中治疗方案的临床疗效、围术期指标、相关并发症及术后再狭窄发生情况。结果双镜组患者无1例无效,痊愈率(80.00%)明显高于对照组(45.00%),差异具有统计学意义(χ~2=11.196,P<0.05);双镜组治疗总有效率为100.00%,明显高于对照组的87.50%,差异具有统计学意义(χ~2=5.977,P<0.05)。除手术时间外,双镜组患者术中出血量、术后排气时间、下床活动时间、术后住院时间、尿管拔除时间患者及DJ管拔除时间均明显优于对照组,差异有统计学意义(均P<0.05);双镜组患者并发症总发生率及术后再狭窄率均明显低于对照组,差异有统计学意义(均P<0.05)。结论腹腔镜输尿管镜双镜联合技术在输尿管狭窄治疗中临床疗效确切,安全性较高且显著减少了术后再狭窄风险,值得临床推广应用。

Objective To compare the efficacy and safety of laparoscopic ureteroscopy combined with ureteroplasty for ureteral stricture.Methods Eighty-five patients with ureteral stricture admitted to our hospital from June 2015 to December 2018 were randomly divided into a double-mirror group(n=45)and a control group(n=40).Patients in the double-mirror group underwent laparoscopic ureteroscopy combined with double-mirror technique,and patients in the control group underwent ureteroplasty.Compare the clinical efficacy,perioperative indicators,related complications,and postoperative restenosis in the treatment regimen.Results All the patients in the double-mirror group were effective,and the cure rate(80.00%)was significantly higher than that of the control group(45.00%).The difference was statistically significant(χ~2=11.196,P<0.05).The total effective rate of the double-mirror group was 100.00%,which was significantly higher than 87.50%of the control group.The difference was statistically significant(X^2=5.977,P<0.05).In addition to the operation time,the intraoperative blood loss,postoperative exhaust time,time to get out of bed,postoperative hospital stay,urinary catheter removal time and DJ tube removal time were significantly better in the double-mirror group than in the control group and the difference was statistically significant(P<0.05).The total incidence of complications and restenosis rate in the double-mirror group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion The laparoscopic ureteroscopy combined with double-mirror technique is effective in the treatment of ureteral stricture,and it is safe and significantly reduces the risk of postoperative restenosis.It is worthy of clinical application.