内镜下不同术式治疗嵌顿性输尿管 上段结石的对比研究

Comparative study on different endoscopic surgical methods of incarcerated upper ureteral calculi

摘要:

目的 了解内镜下不同术式治疗嵌顿性输尿管上段结石的疗效，寻找安全有效的微创术式。 方法 将165例嵌顿性输尿管上段结石患者随机分为3组：MPCNL组45例、URL组43例、RPLU组77例。3组患者分别采用微创经皮肾穿刺取石术（MPCNL）、经尿道输尿管镜碎石术（URL）与后腹腔镜输尿管切开取石术（RPLU）进行治疗。采用视觉模拟评分法评价患者的术后疼痛，比较3组的治疗情况。 结果 MPCNL组与RPLU组的手术成功率均100%；URL组手术成功率83.72%（36/43）。RPLU组的结石取净率为100%；MPCNL组的结石取净率为95.55%（43/45）；URL组结石取净率为86.11%（31/36）。URL组的手术时间、血红蛋白下降值、术后疼痛评分、住院时间、住院费用均显著低于MPCNL组和RPLU组（均P <0.05）；RPLU组的血红蛋白下降值显著低于MPCNL组（P <0.05）；RPLU组和MPCNL组的手术时间、术后疼痛评分、住院时间、住院费用的比较差异均无显著性（均P >0.05）。 结论 MPCNL、URL、RPLU 3种术式均可有效治疗嵌顿性输尿管上段结石，三者各有优劣。

Abstract:

【Objective】 To find out the efficacy of different endoscopic surgical methods of incarcerated upper ureteral calculi and to find the safe and effective minimally invasive surgical procedures. 【Methods】 165 incarcerated upper ureteral calculi patients were randomly divided into three groups: MPCNL group of 45 patients, URL group of 43 cases, and RPLU group of 77 cases. Three groups of patients were treated respectively by minimally invasive percutaneous nephrolithotomy(MPCNL), transurethral ureteroscopy lithotripsy(URL) or retroperitoneal laparoscopic ureterolithotomy(RPLU). The patients' postoperative pain were evaluated by visual analog scale; treatment outcomes of the three groups were compared. 【Results】 The surgical success rate of MPCNL group and RPLU group were both 100%, while success rate of URL group was 83.72% (36/43). Calculi taken rate of RPLU group was 100%; calculi taken rate of MPCNL group was 95.55% (43/45); while calculi taken rate of URL group was 86.11% (31/36). Operative time, decreased hemoglobin values, postoperative pain scores, length of stay, hospital costs of URL group were significantly lower than MPCNL group and RPLU group (P <0.05); decreased hemoglobin values of RPLU group were significantly lower than MPCNL group (P <0.05); operative time, postoperative pain scores, length of stay, hospital costs of RPLU group and MPCNL group showed no significant difference (P >0.05). 【Conclusion】 The three surgical methods, MPCNL, URL and RPLU, were all effective for incarcerated upperureteral calculi, with different advantages and disadvantages.