摘要
目的比较微通道经皮肾镜取石术(MPCNL)、输尿管软镜钬激光碎石术(FURL)、后腹腔镜输尿管切开取石术(RLU)治疗输尿管上段嵌顿性结石的临床疗效。方法回顾性分析2016年1月至2020年6月安徽皖北煤电集团总医院收治的161例单侧输尿管上段嵌顿性结石患者的临床资料,依据不同术式分为三组:MPCNL组54例、FURL组54例、RLU组53例。对比三组患者手术时间、术后住院时间、结石清除率,术前和术后3 d血肌酐(SCr)、血尿素氮(BUN)、血清C反应蛋白(CRP)水平变化以及术后并发症发生情况。结果 FURL组手术时间短于MPCNL组[(59.5±15.6) min比(68.6±14.8) min](P <0.05),RLU组长于MPCNL组和FURL组[(87.9±16.1) min比(59.5±15.6) min、(68.6±14.8) min](P <0.05);FURL组住院时间短于MPCNL组[(3.3±1.1) d比(4.6±1.5) d](P <0.05),RLU组与MPCNL组、FURL组比较差异无统计学意义(P> 0.05);术后3 d,RLU组的结石清除率高于MPCNL组和FURL组[100.0%(53/53)比88.9%(48/54)、85.2%(46/54)](P <0.05)。SCr、BUN、CRP水平的组间和时点间存在交互作用(P <0.05),术前三组患者SCr、BUN、CRP水平比较差异无统计学意义(P> 0.05),术后3 d,RLU组患者SCr、BUN、CRP水平明显低于MPCNL组与FURL组(P <0.05)。三组患者发热、恶心呕吐、尿瘘、泌尿系统感染、输尿管狭窄、围手术期输血及总并发症发生率比较差异无统计学意义(P> 0.05);FURL组输尿管损伤发生率高于MPCNL组(P <0.05),RLU组低于MPCNL组(P <0.05);FURL组和RLU组围手术期输血率低于MPCNL组(P <0.05)。结论与MPCNL、FURL相比,RLU结石清除率较高,有助于肾功能恢复,可明显降低输尿管上段嵌顿性结石术后泌尿系统感染等并发症发生率,但尿瘘及输尿管狭窄的发生率相对较高,临床操作应提高警惕。
Objective To compare the clinical efficacy of mini-percutaneous nephrolithotomy( MPCNL),flexible ureteroscopic lithotripsy( FURL),and retroperitoneal laparoscopic ureterolithotomy( RLU) in the treatment of upper ureteral incarcerated calculi. Methods Retrospective analysis was performed on the clinical data of 161 patients with unilateral upper ureteral incarcerated calculi admitted to Anhui Wanbei Coal-Electricity Group General Hospital from Jan. 2016 to Jun. 2020. They were divided into three groups according to different surgical methods: a MPCNL group( 54 cases),a FURL group( 54 cases) and a RLU group( 53 cases). The duration of surgery,postoperative hospital stay,stone clearance rate,postoperative complications,and changes in serum creatinine( SCr),blood urea nitrogen( BUN),and C-reactive protein( CRP) of the three groups were compared. Results The operation time in the FURL group was shorter than that in the MPCNL group[( 59. 5 ± 15. 6) min vs( 68. 6 ± 14. 8) min]( P < 0. 05),and the RLU group was longer than the MPCNL group and the FURL group[( 87. 9 ± 16. 1) min vs( 59. 5 ± 15. 6) min,( 68. 6 ± 14. 8) min]( P <0. 05). The length of hospital stay in the FURL group was shorter than that in the MPCNL group [( 3. 3 ± 1. 1) d vs( 4. 6 ± 1. 5) d]( P < 0. 05),and there was no significant difference between the RLU group,the MPCNL group and the FURL group( P > 0. 05). The stone clearance rate of the three groups at 3 days after operation was statistically significant( P < 0. 05),and the RLU group was higher than the MPCNL group and the FURL group[100. 0%( 53/53) vs 88. 9%( 48/54),85. 2%( 46/54) ]( P < 0. 05). There were interactions in SCr,BUN,CRP levels between groups and time points( P < 0. 05),there were statistically significantly differences in SCr,BUN,CRP between the three groups before surgery( P > 0. 05),while 3 d after surgery,SCr,BUN,CRP leels in the RLU group were significantly lower than those of the MPCNL group and FURL group( P < 0. 05). There were no significant differences in the incidence of fever,nausea and vomiting,urinary fistula,urinary system infection,ureteral stricture,perioperative blood transfusion and total complications among the three groups( P > 0. 05). The incidence of ureteral injury of the FURL group was higher than the MPCNL group( P < 0. 05),and the RLU group was lower than the MPCNL group( P < 0. 05). The perioperative blood transfusion rate of the FURL group and RLU group were lower than the MPCNL group( P < 0. 05). Conclusion Compared with MPCNL and FURL,RLU has a higher stone clearance rate,which contributes to renal function recovery,and can significantly reduce the incidence of urinary tract infection and other complications after surgery for upper segment incarcerated calculi. However,it also has a higher incidence of urinary fistula and ureteral stricture,calling for high vigilance in the clinical operation.
作者
郭绍永
许培权
孔德志
李虎
GUO Shaoyong;XU Peiquan;KONG Dezhi;LI Hu(Department of Urology,Anhui Wanbei Coal-Electricity Group General Hospital,Suzhou 234000,China;Department of Tumor Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)
出处
《医学综述》
CAS
2021年第10期2050-2055,共6页
Medical Recapitulate
