经腹膜后入路腹腔镜下肾盂切开取石术在治疗肾盂结石中的价值

Value of retroperitoneal laparoscopic pyelolithotomy in the treatment of renal pelvis stones

目的探讨经腹膜后入路腹腔镜下肾盂切开取石术(retroperitoneal laparoscopic pyelolithotomy,RLP)治疗直径>2cm的肾盂结石的围术期及远期疗效和安全性。方法选取2011年6月至2015年6月在甘肃中医药大学第三附属医院泌尿外科就诊的94例直径>2cm的肾盂结石患者为研究对象,根据手术方法不同将研究对象分为RLP组和经皮肾镜碎石术(percutaneous nephrolithotomy,PCNL)组,每组各47例。比较分析两组患者围术期相关指标以及术后并发症发生情况。本研究对两组患者进行了5年的随访,比较分析两组患者的远期结石进展和结石复发情况。结果PCNL组患者的术后血红蛋白下降值显著高于RLP组(P<0.05),而RLP组患者的手术时间和单次排石效率均显著短于或高于PCNL组(P<0.05)。两组患者术后的漏尿、发热(>38.5℃)等并发症发生情况比较差异均无显著性(P>0.05);PCNL组患者术后的脓毒血症发生率显著高于RLP组(P<0.05)。术后5年,PCNL组患者的结石进展率和复发率均显著高于RLP组(P<0.05)。Kaplan-Meier生存曲线显示,RLP组患者的无复发生存率和无进展生存率均显著优于PCNL组(P<0.05)。结论RLP在治疗直径>2cm的肾盂结石患者中具有一定的优势,其结石清除效果更佳,术后的脓毒血症发生率更低,且远期结石进展率及复发率均明显低于PCNL。

Objective To explore the perioperative and long-term efficacy and safety of retroperitoneal laparoscopic pyelolithotomy(RLP)for the treatment of renal pelvis stones with diameter over 2cm.Method A total of 94 patients with renal pelvis stones larger than 2cm in diameter who were admitted to the department of urology in the Third Affiliated Hospital of Gansu University of Chinese Medicine from June 2011 to June 2015 were included.The patients were divided into RLP group and percutaneous nephrolithotomy(PCNL)group according to the different method of surgey,47 cases in each group.Perioperative indicators of patients in the two groups were compared and analyzed,and the long-term progression and recurrence of stones in the two groups were compared and analyzed.Result The decrease value of postoperative hemoglobin in PCNL group was significantly higher than that in RLP group(P<0.05),while the operation time and the single stone discharge efficiency in RLP group were significantly shorter or more than those in PCNL group(P<0.05).There were no significant differences in postoperative complications such as urine leakage,fever between two groups(P>0.05).The incidence of postoperative sepsis in PCNL group was significantly higher than that in RLP group(P<0.05).5 years after surgery,the stone progression rate and recurrence rate in PCNL group were significantly higher than those in RLP group(P<0.05).The relapse-free survival rate and progression-free survival rate in RLP group were significantly better than those in PCNL group(P<0.05).Conclusion RLP has certain advantages in the treatment of patients with pyelolithiasis>2cm in diameter.Its stone removal effect is better,the incidence of postoperative sepsis is lower,and the long-term stone progression rate and recurrence rate are significantly lower than PCNL.