腹膜后腹腔镜输尿管切开取石术治疗嵌顿性输尿管上段结石的疗效及对患者肾功能的影响

Effect of Retroperitoneal Laparoscopic Ureterolithotomy in the Treatment of Incarcerated Upper Ureteral Calculi and Its Influence on Renal Function

目的探讨在嵌顿性输尿管上段结石治疗中应用腹膜后腹腔镜输尿管切开取石术(Retroperitoneal Laparoscopic Ureterolithotomy,RLU)的疗效及对患者肾功能的影响。方法方便选取2020年3月—2022年4月在中国人民解放军联勤保障部队第九〇七医院行手术治疗的64例嵌顿性输尿管上段结石患者为研究对象,通过掷硬币法分为两组,其中通过RLU治疗的32例作为观察组,对照组(n=32)采用微创经皮肾镜碎石术治疗,比较两组结石清除率、手术指标及住院时间、肾功能指标、并发症发生率。结果观察组的结石清除率为100.00%,高于对照组的87.50%,差异有统计学意义(χ^(2)=4.267,P<0.05)。观察组术中失血量较对照组明显减少,且住院时间、手术耗时较对照组明显缩短,差异有统计学意义(P均<0.05)。观察组各项肾功能指标水平均低于对照组,差异有统计学意义(P均<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论临床治疗嵌顿性输尿管上段结石时采用RLU,具有较高的结石清除率,同时能够减少手术创伤,缩短住院时间,对肾功能损伤更小,且有助于降低并发症发生率。

Objective To investigate the effect of retroperitoneal laparoscopic ureterolithotomy(RLU)on renal function in the treatment of incarcerated upper ureteral calculi.Methods 64 patients with incarcerated upper ureteral calculi who underwent surgical treatment in the 907 Hospital of the Joint Logistic Support Force of the People's Liberation Army from March 2020 to April 2022 were conveniently selected as the study objects and were divided into two groups by coin toss method.Among them,32 patients treated by RLU were set as observation group,and the control group(n=32)was treated by minimally invasive percutaneous nephrolithotripsis.The calculi clearance rate,operative indexes,length of hospital stay,renal function indexes and complication rate were compared between the two groups.Results The stone clearance rate in the observation group was 100.00%,which was higher than 87.50%in the control group,and the difference was statistically significant(χ^(2)=4.267,P<0.05).The intraoperative blood loss in the observation group was significantly reduced compared with the control group,and the length of hospital stay and operation time were significantly shortened compared with the control group,and the differences were statistically significant(all P<0.05).The levels of renal function indexes in the observation group were lower than those in the control group,and the differences were statistically significant(all P<0.05).The incidence of complications in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion In the clinical treatment of incarcerated upper ureteral calculi,RLU is a safe and effective treatment,which has a high stone clearance rate,can reduce surgical trauma,shorten hospital stay,reduce renal damage,and help reduce the incidence of complications.