三种微创手术治疗输尿管上段复杂结石的对比研究

发布时间：2018-07-15 13:33

【摘要】：目的：比较输尿管镜碎石术(ureteroscopy lithotripsy,URL)、经皮肾镜碎石术(percutaneous nephrolithotomy,PCNL)、后腹腔镜输尿管切开取石术(retroperitoneal laparoscopic ureterolithotomy,RLUL)等三种腔镜手术治疗输尿管上段复杂结石的疗效。以确定三种微创治疗方法的优劣性及最佳适应症。方法：查阅近年来关于腔镜治疗输尿管上段结石的重要文献资料，并搜集近两年我院泌尿外科使用腔镜治疗输尿管上段结石的患者共213例，其中输尿管镜碎石术治疗58例、经皮肾镜碎石治疗72例、后腹腔镜输尿管切开取石治疗83例，严格按照入组标准，从三组中每组选取30例患者进行统计学分析，对各组手术时间、血红蛋白下降值、住院天数、住院费用、术后结石清除率、并发症发生率等指标进行对比分析，采用SPSS16.0统计软件进行数据分析。结果：（1）URL组、PCNL组、RLUL组手术时间分别为34.63±3.67min、64.40±6.17min、61.30±5.72min，统计学分析表明URL组手术时间明显短于PCNL组、RLUL组，P值均小于0.01；而PCNL组与RLUR组手术时间无明显差异。（2）URL组、PCNL组、RLUL组术中血红蛋白下降值分别为4.17±1.8g/L、20.67±3.43g/L、8.63±2.59g/L，根据统计学分析，RLUL组血红蛋白下降值要高于URL组，但要明显低于PCNL组(P＜0.01）。（3）URL组、PCNL组、RLUL组住院天数分别为4.23±1.50ds、8.23±1.43ds、6.43±1.38ds。统计学分析表明RLUL组住院时间要长于URL组，但是要短于PCNL组(P＜0.01）。（4）URL组、PCNL组、RLUL组住院费用分别为：5329±1531、10259±2598、13182±2177元。统计学分析表明PCNL组住院费用要明显高于URL组，但是明显低于RUL组(P＜0.01）。（5）术后1周复查泌尿系彩超或者KUB，残留碎石小于4mm者视为碎石成功。URL组共有4例患者术后出现大于4mm的残留结石，需ESWL辅助治疗。URL组、PCNL组、RLUL组术后1周结石清石率分别为：86.6%、100%、100%，统计学分析表明PCNL组和RLUL组术后结石清除率均要明显高于URL组，P值＜0.05。（6）URL组有两例出现发热，无出血、输尿管穿孔、继发输尿管狭窄等并发症出现；PCNL组分别有2例出现发热、2例出现出血；RLUL组仅有1例出现了漏尿、1例出现皮下气肿。URL组、PCNL组、RLUL组并发症发生率分别为：6.67%、13.3%、6.67%。经过统计学分析发现以上三组并发症发生率无明显差异（P＞0.05）。结论：虽然URL具有住院时间短、手术创伤小等优势，但是其治疗效果欠佳。PCNL治疗治疗效果好、清石率高，尤其是用于治疗输尿管镜进镜困难或者体积较大的高位结石，但是其术后并发症多。在技术条件成熟的医院,RLUL可逐渐代替开放手术,成为治疗输尿管上段复杂结石的首选术式。
[Abstract]:Objective: to compare the efficacy of ureteroscopy lithotripsy (ureteroscopy), percutaneous lithotripsy (PCNL) and retroperitoneal laparoscopic ureterolithotomy (retroperitoneal laparoscopic ureterolithotomy) in the treatment of complex upper ureteral calculi. In order to determine the advantages and disadvantages of three minimally invasive treatment methods and the best indications. Methods: to review the important literature on endoscopic treatment of upper ureteral calculi in recent years, and to collect 213 cases of ureteral calculi treated by endoscopy in our hospital in recent two years, among which 58 cases were treated by ureteroscopic lithotripsy. 72 cases were treated with percutaneous nephrolithotripsy, 83 cases were treated with retroperitoneal laparoscopic ureterolithotomy. According to the standard of entry, 30 patients in each group were selected for statistical analysis. The time of operation, the decrease of hemoglobin and the days of hospitalization were analyzed. The hospital expenses, postoperative stone clearance rate and complication rate were compared. SPSS 16.0 statistical software was used to analyze the data. Results: (1) the operative time of RLUL group was 34.63 卤3.67 min, 64.40 卤6.17 min, 61.30 卤5.72 min, respectively. Statistical analysis showed that the operative time of URL group was significantly shorter than that of PCNL RLUL group (P < 0.01). However, there was no significant difference in the operative time between PCNL group and RLUR group. (2) the decrease of hemoglobin in RLUL group was 4.17 卤1.8 g / L, 20.67 卤3.43 g / L respectively. According to statistical analysis, the decrease value of hemoglobin in RLUL group was higher than that in URL group. But the days of hospitalization in RLUL group were significantly lower than those in PCNL group (P < 0. 01). (3). The days of hospitalization in RLUL group were 4. 23 卤1. 50 dsL, 8. 23 卤1. 43 dsL, 6. 43 卤1. 38dsrespectively. Statistical analysis showed that the hospitalization time of RLUL group was longer than that of). (group, but shorter than that of PCNL group (P < 0. 01). (4). Statistical analysis showed that the cost of hospitalization in PCNL group was significantly higher than that in URL group. But it was significantly lower than that in RUL group (P < 0. 01). (5). 4 patients with residual lithotripsy less than 4mm had residual stones larger than 4mm after operation. The stone clearance rate of RLUL group 1 week after operation was 1: 86.6% and 100% respectively. Statistical analysis showed that the stone clearance rate in PCNL group and RLUL group was significantly higher than that in URL group (P < 0.05). (6) two cases in URL group had fever, no bleeding, ureteral perforation. Complications such as secondary ureteral stenosis were found in 2 cases of fever and 2 cases of hemorrhage in RLUL group. In RLUL group, there were only 1 case with leakage of urine and 1 case with subcutaneous emphysema. The complication rate of RLUL group in PCNL group was: 6.6.67% and 13.3% respectively. Statistical analysis showed that there was no significant difference in the incidence of complications among the above three groups (P > 0.05). Conclusion: although URL has the advantages of short hospital stay and less surgical trauma, it has a poor therapeutic effect. PCNL has a high rate of stone clearance, especially for the treatment of ureteroscopic stones with difficult access to endoscopy or large volume of high stones. But there are many postoperative complications. RLUL can gradually replace open surgery and become the first choice for the treatment of upper ureteral complex stones.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699

【参考文献】