微创经皮肾镜碎石术与输尿管软镜碎石术在治疗直径大于1 cm输尿管上段结石的临床疗效对比
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摘要
目的:探讨微创经皮肾镜碎石术(MPCNL)与输尿管软镜碎石术(FURS)在治疗直径大于1 cm输尿管上段结石的临床疗效对比。方法:选择2014年8月-2016年8月期间治疗的62例输尿管上段结石(直径大于1cm)患者作为研究对象,根据手术方式不同(MPNCNL和FURS)采用随机数字表法随机分为MPCNL组和FURS组,两组患者均为31例,术后随访1个月,比较两组在手术时间、术中出血量、住院时间、住院费用、并发症发生率、术后1个月结石清除率的异同。结果:MPCNL组在术中出血量、住院时间、并发症发生率方面高于FURS组,差异有统计学意义(P<0.05)。MPCNL组在手术时间、住院费用、术后1个月结石清除率方面与FURS组无明显区别,差异无统计学意义(P>0.05)。结论:同MPCNL相比,FURS在治疗直径大于1 cm输尿管上段结石过程中可减少患者术中出血、降低并发症发生率,缩短住院时间,具有创伤小、安全性高等优点,更值得在临床推广应用。
Objective:To compare the clinical efficacy of minimally invasive percutaneous nephrolithotomy(MPCNL)vs. flexible ureteroscopic lithotripsy(FURS)in the treatment of upper ureteral calculi with diameter great?er than 1 cm.Methods:Sixty-two patients with upper ureteral calculi(diameter greater than 1 cm)treated in our hos?pital from August 2014 to August 2016 were randomly divided into two groups(MPCNL group and FURS group)according to different surgical methods(MPCNL and FURS). Both groups had 31 patients. The follow-up time was 1 month after operation. The operative time,intraoperative bleeding volume,and blood loss were compared between the two groups. The differences in hospital stay,hospitalization expenses,complication rate and stone clearance rate after 1 month were compared.Results:The amount of bleeding,hospital stay and complication rate in MPCNL group were significantly increased as compared with those in FURS group(P<0.05). There was no significant differ?ence between MPCNL group and FURS group in operation time,hospitalization cost and stone clearance rate at 1 month after operation(P>0.05).Conclusion:Compared with MPCNL,FURS can reduce intraoperative blood loss,complication rate and hospital stay in the treatment of upper ureteral calculi with diameter greater than 1 cm. It has the advantages of small trauma and high safety and is worthy of clinical application.
Objective:To compare the clinical efficacy of minimally invasive percutaneous nephrolithotomy(MPCNL)vs. flexible ureteroscopic lithotripsy(FURS)in the treatment of upper ureteral calculi with diameter great?er than 1 cm.Methods:Sixty-two patients with upper ureteral calculi(diameter greater than 1 cm)treated in our hos?pital from August 2014 to August 2016 were randomly divided into two groups(MPCNL group and FURS group)according to different surgical methods(MPCNL and FURS). Both groups had 31 patients. The follow-up time was 1 month after operation. The operative time,intraoperative bleeding volume,and blood loss were compared between the two groups. The differences in hospital stay,hospitalization expenses,complication rate and stone clearance rate after 1 month were compared.Results:The amount of bleeding,hospital stay and complication rate in MPCNL group were significantly increased as compared with those in FURS group(P<0.05). There was no significant differ?ence between MPCNL group and FURS group in operation time,hospitalization cost and stone clearance rate at 1 month after operation(P>0.05).Conclusion:Compared with MPCNL,FURS can reduce intraoperative blood loss,complication rate and hospital stay in the treatment of upper ureteral calculi with diameter greater than 1 cm. It has the advantages of small trauma and high safety and is worthy of clinical application.
引文
[1]那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南.北京:人民卫生出版社,2013:187-189.
[2]万磊,乐有为,莫卒,等.微创经皮肾镜碎石术联合输尿管软镜治疗嵌顿性输尿管上段结石的疗效分析.临床医学工程,2017,24(9):1201-1202.
[3]林天旗,许振强,林海利,等.输尿管软镜联合硬镜与微创经皮肾镜治疗复杂性输尿管上段结石应用比较.临床泌尿外科杂志,2018,33(3):235-237,241.
[4]魏红兵,白涛,余文华,等.三种微创术式治疗复杂性输尿管上段结石的疗效分析.国际泌尿系统杂志,2016,36(2):177-181.
[5]张宇,李九智,姜有涛,等.微创经皮肾镜与输尿管软镜治疗2~4cm肾下盏结石的比较.中华腔镜泌尿外科杂志(电子版),2018,12(2):111-115.
[6]石英,张悦,李凯,等.经皮肾镜和输尿管软镜钬激光碎石分阶段处理复杂性肾结石临床探讨.重庆医学,2017,46(5):687-689.
[7]杨文增,崔振宇,安丰,等.输尿管软镜与微通道经皮肾镜在输尿管上段结石治疗中的对比研究.中国内镜杂志,2016,22(11):11-14.
[8]王官峰,陈如,马锋.输尿管软镜碎石术联合微创经皮肾镜取石术治疗部分鹿角状肾结的临床疗效分析.临床外科杂志,2017,25(4):304-306.
[9] TOPALOGLU H,KARAKOYUNLU N,SARI S,et al.A comparison of antegrade percutaneous and laparo‐scopic approaches in the treatment of proximal ureteralstones. Biomed Res Int,2014,2014:691946.
[10]桂志明,苏劲,柳健军,等.输尿管软镜钬激光碎石术与经皮肾镜取石术治疗输尿管上段大结石的疗效比较.临床泌尿外科杂志,2017,32(1):61-64.
[11]刘霄鹏,傅发军,黎勇林,等.输尿管软镜技术治疗输尿管上段结石手术技巧探讨.国际泌尿系统杂志,2016,36(6):839-841.
[12] BA?O,TUYGUN C,DEDE O,et al. Factors affect‐ing complication rates of retrograde flexible ureterore‐noscopy:analysis of 1571 procedures--a single-centerexperience. World J Urol,2017,35(5):819-826.
[13]段瑞华,梅力,张毅.输尿管软镜钬激光碎石术与经皮肾镜钬激光碎石术治疗输尿管上段结石的疗效比较.临床合理用药杂志,2016,9(4):32-34.
[14]程跃,严泽军,谢国海,等.“粉末化碎石”在输尿管软镜治疗肾结石中的应用.微创泌尿外科杂志,2013,2(3):210-212.
[15]谭小宇,陈瑶,唐园,等.输尿管软镜碎石术与经皮肾镜碎石术治疗输尿管上段结石的疗效比较.微创泌尿外科杂志,2016,5(3):154-157.
[16] HUSSAIN M,ACHER P,PENEV B,et al. Redefin‐ing the limits of flexible ureterorenoscopy. J Endourol,2011,25(1):45-49.
[2]万磊,乐有为,莫卒,等.微创经皮肾镜碎石术联合输尿管软镜治疗嵌顿性输尿管上段结石的疗效分析.临床医学工程,2017,24(9):1201-1202.
[3]林天旗,许振强,林海利,等.输尿管软镜联合硬镜与微创经皮肾镜治疗复杂性输尿管上段结石应用比较.临床泌尿外科杂志,2018,33(3):235-237,241.
[4]魏红兵,白涛,余文华,等.三种微创术式治疗复杂性输尿管上段结石的疗效分析.国际泌尿系统杂志,2016,36(2):177-181.
[5]张宇,李九智,姜有涛,等.微创经皮肾镜与输尿管软镜治疗2~4cm肾下盏结石的比较.中华腔镜泌尿外科杂志(电子版),2018,12(2):111-115.
[6]石英,张悦,李凯,等.经皮肾镜和输尿管软镜钬激光碎石分阶段处理复杂性肾结石临床探讨.重庆医学,2017,46(5):687-689.
[7]杨文增,崔振宇,安丰,等.输尿管软镜与微通道经皮肾镜在输尿管上段结石治疗中的对比研究.中国内镜杂志,2016,22(11):11-14.
[8]王官峰,陈如,马锋.输尿管软镜碎石术联合微创经皮肾镜取石术治疗部分鹿角状肾结的临床疗效分析.临床外科杂志,2017,25(4):304-306.
[9] TOPALOGLU H,KARAKOYUNLU N,SARI S,et al.A comparison of antegrade percutaneous and laparo‐scopic approaches in the treatment of proximal ureteralstones. Biomed Res Int,2014,2014:691946.
[10]桂志明,苏劲,柳健军,等.输尿管软镜钬激光碎石术与经皮肾镜取石术治疗输尿管上段大结石的疗效比较.临床泌尿外科杂志,2017,32(1):61-64.
[11]刘霄鹏,傅发军,黎勇林,等.输尿管软镜技术治疗输尿管上段结石手术技巧探讨.国际泌尿系统杂志,2016,36(6):839-841.
[12] BA?O,TUYGUN C,DEDE O,et al. Factors affect‐ing complication rates of retrograde flexible ureterore‐noscopy:analysis of 1571 procedures--a single-centerexperience. World J Urol,2017,35(5):819-826.
[13]段瑞华,梅力,张毅.输尿管软镜钬激光碎石术与经皮肾镜钬激光碎石术治疗输尿管上段结石的疗效比较.临床合理用药杂志,2016,9(4):32-34.
[14]程跃,严泽军,谢国海,等.“粉末化碎石”在输尿管软镜治疗肾结石中的应用.微创泌尿外科杂志,2013,2(3):210-212.
[15]谭小宇,陈瑶,唐园,等.输尿管软镜碎石术与经皮肾镜碎石术治疗输尿管上段结石的疗效比较.微创泌尿外科杂志,2016,5(3):154-157.
[16] HUSSAIN M,ACHER P,PENEV B,et al. Redefin‐ing the limits of flexible ureterorenoscopy. J Endourol,2011,25(1):45-49.