输尿管镜钬激光碎石术与后腹腔镜输尿管切开取石术治疗输尿管中上段结石的疗效比较

Comparison of the efficacy of ureteroscopic holmium laser lithotripsy and retroperitoneal laparoscopic ureterolithotomy in the treatment of middle and upper ureteral calculi

目的比较输尿管镜钬激光碎石术(UHLL)和后腹腔镜输尿管切开取石术(RLU)治疗输尿管中上段结石的临床疗效。方法70例输尿管中上段结石患者,按照手术方式不同分为UHLL组(n=35,UHLL治疗)和RLU组(n=35,RLU治疗)。对比两组围术期指标、炎症指标、并发症发生率、清石效果。结果UHLL组术中出血量(5.31±0.59)ml少于RLU组的(12.35±2.12)ml,手术时间(54.25±14.13)min、住院时间(4.22±0.75)d短于RLU组的(72.52±15.26)min、(6.21±0.86)d(P<0.05)。术前1 d,RLU组和UHLL组白细胞介素-6(IL-6)、降钙素原(PCT)、C反应蛋白(CRP)水平对比无统计学差异(P>0.05);术后1 d,UHLL组IL-6、PCT、CRP水平较RLU组略有升高,但无统计学差异(P>0.05)。UHLL组术后并发症发生率为8.57%,较RLU组的2.86%略高,但无统计学差异(P>0.05);术后随访6~12个月,RLU组和UHLL组清石率分别为100.00%、97.14%,对比无统计学差异(P>0.05)。结论UHLL与RLU治疗输尿管中段结石均具有较为可靠的效果和安全性,但UHLL手术时间短、术中出血量少、术后恢复快;如果输尿管上段结石存在上移肾盂可能,宜选择RLU治疗。

Objective To compare the clinical efficacy of ureteroscopic holmium laser lithotripsy(UHLL)and retroperitoneal laparoscopic ureterolithotomy(RLU)in the treatment of middle and upper ureteral calculi.Methods 70 patients with middle and upper ureteral calculi were divided into UHLL group(n=35)and RLU group(n=35)according to different surgical methods.The perioperative indexes,inflammatory indexes,complications,and stone removal effect and were compared between the two groups.Results The amount of intraoperative blood loss of(5.31±0.59)ml in UHLL group was less than(12.35±2.12)ml in RLU group;the operation time and length of hospital stay were(54.25±14.13)min and(4.22±0.75)d in UHLL group,which were shorter than(72.52±15.26)min and(6.21±0.86)d in RLU group(P<0.05).1 d before surgery,there were no significant differences in the levels of interleukin-6(IL-6),procalcitonin(PCT)and C-reactive protein(CRP)between RLU group and UHLL group(P>0.05).1 d after surgery,the levels of IL-6,PCT and CRP in UHLL group were slightly higher than those in RLU group,but there was no statistical difference(P>0.05).The incidence of postoperative complications in UHLL group was 8.57%,which was slightly higher than 2.86%in RLU group,but there was no statistical difference(P>0.05).After 6-12 months of follow-up,the stone removal rate of RLU group and UHLL group were 100.00%and 97.14%,and there was no statistical difference(P>0.05).Conclusion Both UHLL and RLU have relatively reliable effects and safety in the treatment of middle ureteral calculi,but the former has short operation time,less amount of intraoperative blood loss and quick postoperative recovery,and the upper ureteral calculi may migrate up the renal pelvis,so RLU should be selected.