比较3种微创术式治疗肥胖患者输尿管上段结石效果

Comparison of Three Minimally Invasive Surgical Procedures for Upper Ureteral Calculi in Obese Patients

目的比较输尿管镜碎石(URL)、经皮肾镜碎石(PCNL)、后腹腔镜下输尿管切开取石(RPLU)治疗肥胖患者输尿管上段结石的效果。方法回顾性分析2010年5月至2019年5月收治的91例输尿管上段结石患者的临床资料,BMI>24 kg·m^-2,均行微创治疗手术。分别采用URL(URL组,n=30)、PCNL(PCNL组,n=34)、RPLU(RPLU组,n=27)治疗。比较3组术后结石清除率、手术时间、住院时间和手术并发症(大出血、发热、明显肉眼血尿、尿路感染及严重感染等)发生率。结果术后1周和1个月结石清除率从高到低依次为RPLU组(100%、100%)、PCNL组(85%、97%)、URL组(83%、93%),3组比较差异无统计学意义(P>0.05);URL组、PCNL、RPLU组手术时间分别为(70.5±36.2)、(102.4±42.5)、(115.3±52.3)min,住院时间分别为(5.2±2.4)、(10.0±4.1)、(10.4±3.7)d,URL组手术和住院时间明显短于PCNL组和RPLU组(P<0.05);3组术后并发症发生率比较差异无统计学意义(P>0.05)。结论对肥胖患者输尿管上段结石的治疗,URL与PCNL和RPLU的效果相当,且手术和住院时间更短,患者耐受性更好。

Objective To compare the effects of ureteroscopic lithotripsy(URL),percutaneous nephrolithotomy(PCNL)and retroperitoneal laparoscopic ureterolithotomy(RPLU)on upper ureteral calculi in obese patients.Methods Clinical data of 91 patients with upper ureteral calculi(BMI>24 kg·m^-2)who received URL(n=30),PCNL(n=34)or RPLU(n=27)between May 2010 and May 2019 were analyzed retrospectively.Stone clearance rate,operation time,hospitalization time and surgical complications(massive hemorrhage,fever,gross hematuria,urinary tract infection and serious infection)were compared among the three groups.Results One week and 1 month after operation,the stone clearance rates were respectively 100%and 100%in RPLU group,85%and 97%in PCNL group,and 83%and 93%in URL group.There were no significant differences in stone clearance rate and incidence of complications among the three groups(P>0.05).The operation time and hospital stay in URL group((70.5±36.2)minutes and(5.2±2.4)days,respectively)were shorter than those in PCNL group((102.4±42.5)minutes and(10.0±4.1)days,respectively)and RPLU group((115.3±52.3)minutes and(10.4±3.7)days,respectively)(P<0.05).Conclusion URL has the same effect with PCNL and RPLU on upper ureteral calculi in obese patients.Furthermore,URL is superior to PCNL and RPLU for shortening operation time and hospital stay and improving patient tolerance.