4种微创术式对单侧直径>1 cm输尿管上段结石的疗效比较

Influence of different kinds of minimally invasive procedures on stone clearance, surgical-related clinical parameters and postoperative complications of patients with upper ureteral calculi for diameter >1 cm

摘要:

摘要：目的 探讨输尿管硬镜碎石术（URL）、后腹腔镜输尿管切开取石术（RLU）、经皮肾镜取石术（PCNL）和输尿管软镜碎石术（FURL）对直径>1 cm输尿管上段结石患者的结石清除率、手术相关临床指标及术后并发症的影响。方法 选取该院2015年9月－2018年3月收治的直径>1 cm输尿管上段结石患者共160例，以随机数字表法分为A组（40例）、B组（40例）、C组（40例）及D组（40例），分别采用URL、RLU、PCNL及FURL治疗。比较4组患者术后第3天和1个月结石清除率、手术时间、治疗费用、术后胃肠道蠕动恢复时间、术后住院时间、血红蛋白（Hb）降低值、术后需体外冲击波碎石（ESWL）率及术后并发症等的差异。结果 B、C及D组患者结石清除效果均明显优于A组（P <0.05）；A组患者手术时间、治疗费用、术后胃肠道蠕动恢复时间、术后住院时间及Hb降低值均明显少于B、C及D组（P <0.05）；D组患者治疗费用明显高于A、B及C组（P <0.05）；C组患者Hb降低值明显高于A、B及D组（P <0.05）；4组患者术后需ESWL率和术后并发症发生率比较，差异均无统计学意义（P >0.05）。结论 URL治疗直径>1 cm输尿管上段结石可明显缩短手术时间，降低治疗费用，加快术后机体康复进程，并有助于减少医源性创伤程度，但结石清除效果欠佳；FURL术操作难度和治疗费用均较高；PCNL尽管结石清除效果满意，但术中医源性创伤程度较大；而RLU亦存在手术难度高问题，可作为FURL或PCNL失败后补救手段加以应用。

Abstract:

Abstract: Objective To investigate the influence of URL, RLU, PCNL and FURL on stone clearance, surgical-related clinical parameters and postoperative complications of patients with upper ureteral calculi for diameter >1 cm. Methods 160 patients with upper ureteral calculi for diameter >1 cm were chosen from September 2015 to March 2018 and randomly divided into 4 groups including A group (40 patients) with URL, B group (40 patients) with RLU, C group (40 patients) with PCNL and D group (40 patients) with FURL; Comparison of stone clearance rate at day 3 and at 1 month after operation, operation time, treatment cost, postoperative recovery time of gastrointestinal peristalsis, postoperative hospitalization time, the levels of Hb reduction, postoperative ESWL requirement rate and postoperative complications incidence of 4 groups were compared. Results The stone clearance effects of B group, C group and D group were significantly better than A group (P < 0.05). The operation time, treatment cost, postoperative recovery time of gastrointestinal peristalsis, postoperative hospitalization time and the levels of Hb reduction of A group were significantly less than B group, C group and D group (P < 0.05). The treatment cost of D group were significantly more than A group, B group and C group (P < 0.05). The levels of Hb reduction of C group were significantly higher than A group, B group and MPCNL group (P < 0.05). There was no significant difference in the postoperative ESWL requirement rate and postoperative complications incidence among 4 groups (P > 0.05). Conclusion URL in the treatment of patients with upper ureteral calculi for diameter >1 cm can efficiently shorten the operation time, decrease the treatment costs, speed up the recovery process and be helpful to reduce the iatrogenic trauma degree, but possess the wore stone removal effects; FURL have the higher operation difficulty and treatment expense; PCNL possess satisfactory stone removal effect but combined with the higher iatrogenic trauma degree; and RLU also possess the problem of high operation difficulty which can be used to remedy scheme for failure after FURL or PCNL.