两种输尿管上段结石手术的疗效安全性和费用比较

目的 比较和分析经尿道输尿管镜钬激光碎石术和后腹腔镜下输尿管切开取石术在处理单纯输尿管上段≥1cm结石时在清石率、并发症和经济效益等方面的差异.方法 收集2018年1月至2019年12月因输尿管结石在本院行微创手术的202例患者的临床数据,其中经尿道输尿管镜钬激光碎石术(A组)143例,后腹腔镜下输尿管切开取石术(B组)59例.比较两组患者在手术时间、高年资医生手术参与率、术后住院时间、并发症、术后1个月结石清除率、平均住院次数、平均手术次数和医疗费用等方面的差异.结果 A组的手术时间明显短于B组(P<0.05);A组的高年资医生手术参与率明显低于B组(P<0.05),A组术后住院天数明显短于B组(P<0.05);A组术后出现了5例感染性休克和3例输尿管狭窄,B组未出现上述并发症;A组术后1个月清石率明显低于B组(P<0.05).A组平均住院次数和平均手术次数均多于B组,整体治疗费用也高于B组.结论 对于单纯输尿管上段较大的结石,后腹腔镜手术虽然难度较大,术后住院时间长,但是手术效果确切,安全性高,经济效益好,具有较高的应用价值.

Objective To compare the efficacy,complications and cost of transurethral ureteroscopic holmium laser lithotripsy and retroperitoneal laparoscopic ureterolithotomy for treatment of the simple upper ureteral stones≥1cm.Methods The clinical data of 202 patients who underwent transurethral ureteroscopic holmium laser lilthotripsy(143)or retroperitoneal laparoscopic ureterolithotomy(59)in our center from January 2018 to December 2019 were retrospectively analyzed.Results The operation time of the laparoscopy group was significantly longer than that of the ureteroscope group(P<0.05),and the postoperative hospital time was also significantly prolonged(P<0.05).Senior surgeons participating rate was significantly higher in the laparoscopy group(P<0.05).There were 5 cases of septic shock and 3 cases of ureteral stricture in ureteroscope group,while there were no such complications in laparoscopy group.The 1 month stone clear rate was significantly higher in the laparoscopy group than that in the ureteroscopy group(P<0.05).The average number of hospitalizations and operations in ureteroscopy group was higher than that in laparoscopy group,and the overall cost was also higher than that in laparoscopy group.Conclusion For simple upper ureteral calculi ≥1cm,although retroperitoneal laparoscopic ureterolithotomy is difficult to perform and the postoperative hospitalization time is long,the stone clear rate,safety and economic benefit are advantageous.