后腹腔镜输尿管切开取石术治疗单侧输尿管上段结石的临床应用

Clinical application of retroperitoneal laparoscopic ureterolithotomy in the treatment of unilateral upper ureteral calculi

目的探析后腹腔镜输尿管切开取石术(RLUL)治疗单侧输尿管上段结石的临床应用。方法选取2019年1月至2021年12月于本院接受治疗的24例输尿管中上段结石患者作为研究对象,采用信封法分为观察组和对照组,每组12例。对照组中7例患者实施经皮肾镜取石术(PCNL)联合双镜治疗,5例经尿道输尿管硬镜碎石术(URL)治疗后结石回落肾盂内二期行输尿管软镜术治疗,观察组均采用治疗RLUL,比较两组临床指标(手术时间、术中出血量、卧床时间、住院时间、结石清除率及住院费用)、应激指标[C反应蛋白(CRP)、内皮素-1(ET-1)及皮质醇(Cor)]及术后15 d并发症发生情况。结果观察组手术时间长于对照组,术中出血量、住院费用均少于对照组,卧床时间、住院时间均短于对照组,差异有统计学意义(P<0.05);两组结石清除率比较差异无统计学意义。术后7 d,两组CRP、ET-1、Cor水平均低于术后1 d,差异有统计学意义(P<0.05);术后1、7 d,观察组CRP、ET-1、Cor水平均低于对照组,差异有统计学意义(P<0.05)。两组术后并发症发生率比较差异无统计学意义。结论RLUL术可实现对单侧输尿管上段结石患者的完整取石,有效改善患者应激反应,缩短卧床时间及住院时间,且术中出血量低,安全性较高,值得基层医院临床推广。

Objective To explore the clinical effect of retroperitoneal laparoscopic ureterolithotomy(RLUL)in the treatment of unilateral upper ureteral calculi.Methods 24 patients with upper and middle ureteral calculi who were treated in our hospital from January 2019 to December 2021 were selected as the study subjects,and they were divided into observation group and control group by envelope method,with 12 cases in each group.In the control group,7 patients were treated with percutaneous nephrolithotomy(PCNL)combined with double endoscopy,and 5 patients were treated with ureteroscopy in the second stage after ureteroscopic lithotripsy(URL),the observation group was treated with RLUL,and the clinical indexes of the two groups(operation time,intraoperative bleeding,bed time,hospital stay,stone clearance rate and hospital expenses)were compared stress indexes(C-reactive protein[CRP],endothelin-1[ET-1]and cortisol[COR])and the occurrence of complications 15 d after operation.Results The operation time of the observation group was longer than that of the control group,the intraoperative bleeding and the hospital expenses were less than that of the control group,and the bed time and hospital stay were shorter than that of the control group,the difference was sta⁃tistically significant(P<0.05);there was no significant difference in stone clearance between the two groups.On the 7th day after operation,the levels of CRP,ET-1 and cor in the two groups were lower than those on the 1st day after operation,the difference was statistically significant(P<0.05);at 1 and 7 d after operation,the levels of CRP,ET-1 and cor in the observation group were lower than those in the control group,the differ⁃ence was statistically significant(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups.Conclusion RLUL can achieve complete stone removal for patients with unilateral upper ureteral calculi,effectively improve the patient's stress response,shorten the bed time and hospital stay,and have low intraoperative bleeding and high safety,it is worthy of clinical promotion in grass-roots hospitals.