不同微创术式治疗肾盂输尿管连接部梗阻并肾结石的效果比较

Comparison of the efficacies of different minimally invasive procedures in the treatment of UPJO complicated with renal calculi

目的比较腹腔镜下肾盂成形术分别联合输尿管软镜碎石术、经皮肾镜碎石术治疗肾盂输尿管连接部梗阻(UPJO)并肾结石的临床疗效。方法选取2018年7月—2021年12月四川省达州市中心医院收治的63例UPJO并肾结石患者,随机分为输尿管软镜组(32例)、经皮肾镜组(31例)。观察2组手术相关指标,术前1 d及术后1、3 d疼痛视觉模拟评分(VAS),术后肾积水,结石清除率及并发症发生率。结果输尿管软镜组较经皮肾镜组术中出血量更少[(62.35±3.14)mL vs.(76.17±2.36)mL,P<0.001]、术后住院时间更短[(6.09±1.31)d vs.(8.34±1.27)d,P<0.001],但碎石时间较经皮肾镜组长[(34.17±7.47)min vs.(29.56±6.61)min,P=0.012];两组术后1、3 d VAS评分均较术前1 d升高(P<0.05),但术后1 d VAS评分输尿管软镜组低于经皮肾镜组(P<0.05);两组术后肾积水、结石清除率及并发症发生率比较差异无统计学意义(P>0.05)。结论腹腔镜下肾盂成形术分别联合输尿管软镜碎石术、经皮肾镜碎石术均有较好的肾积水及结石清除率,安全性均良好,但联合输尿管软镜碎石术术中出血量较少,术后疼痛较轻且恢复更快,更具优越性。

Objective To compare the clinical efficacies of laparoscopic pyeloplasty combined with ureteroscopic lithotripsy or percutaneous nephrolithotripsy in the treatment of ureteropelvic junction obstruction(UPJO)with renal calculi.Methods A total of 63 patients with UPJO complicated with renal calculi treated in our hospital during Jul.2018 and Dec.2021 were randomly divided into ureteroscopic group(n=32)and percutaneous group(n=31).The operation related indexes,visual analogue scale(VAS)of pain 1 day before operation,1 day and 3 days after operation,postoperative hydronephrosis,stone-clearance rate and complication rate were observed.Results Compared with the percutaneous group,the ure-teroscopic group had less intraoperative bleeding[(62.35±3.14)mL vs.(76.17±2.36)mL,P<0.001]and shorter postopera-tive hospital stay[(6.09±1.31)d vs.(8.34±1.27)d,P<0.001],but longer lithotripsy time[(34.17±7.47)min vs.(29.56±6.61)min,P=0.012].VAS scores 1 day and 3 days after operation in the two groups were higher than those 1 day before operation(P<0.05),but VAS score 1 day after operation in ureteroscopic group was lower than that in percutaneous group(P<0.05).There were no significant differences in the incidence of postoperative hydronephrosis,stone-clearance rate and complications between the two groups(P>0.05).Conclusion Laparoscopic pyeloplasty combined with ureteroscopic lithotripsy or percutaneous nephrolithotripsy have good hydronephrosis and stone-clearance rate and good safety.Laparoscopic pyelo-plasty combined with ureteroscopic lithotripsy produces less bleeding,less pain but faster recovery.