经腹腹腔镜与微通道经皮肾镜治疗输尿管上段结石比较性研究
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摘要
目的:比较经腹腹腔镜取石术与微通道经皮肾镜碎石术治疗输尿管上段结石的临床疗效。方法:回顾性分析2016年3月-2018年1月诊治的84例输尿管上段结石患者资料,其中41例患者行经腹腹腔镜输尿管切开取石术,43例患者行微通道经皮肾镜钬激光碎石术,比较两组患者手术时间、术中出血量、结石清除率、术后并发症、术后住院时间、术后肾积水恢复情况。结果:平均手术时间腹腔镜组(50.3±11.1)min短于经皮肾镜组的(78.5±16.8)min;平均术中出血量腹腔镜组(15.5±2.7)mL少于经皮肾镜组(89.4±20.6)mL;两组患者结石清除率无差别;总并发症腹腔镜组为38例,经皮肾镜组为29例,行分级研究发现腹腔镜组疼痛发生率(92.7%)高于经皮肾镜组(25.4%),术后感染、肾周血肿等并发症发生率经皮肾镜组(23.3%、18.6%)高于腹腔镜组,腹腔镜组无该类并发症的发生;术后住院时间腹腔镜组(8.1±0.7)d,与经皮肾镜组(6.8±2.3)d比较差异无统计学意义(P>0.05);术后3个月复查肾积水恢复情况,两组患者均差异无统计学意义。结论:与微通道经皮肾镜治疗输尿管上段结石相比,经腹腹腔镜组手术时间短、出血少、严重并发症少,但是术后切口疼痛明显。
Objective:To compare the clinical efficacy of transabdominal laparoscopy and microchannel percutaneous nephroscopy in the treatment of upper ureteral calculi.Methods:From March 2016 to January 2018,84 patients with upper ureteral calculi were retrospectively analyzed. Laparoscopic transabdominal ureterolithotomy was performed on 41 patients. Microchannel percutaneous nephrolithotomy with holmium laser lithotripsy was performed on 43 patients. The operation time,intraoperative blood loss,stone clearance rate,postoperative complications,hospitalization time and recovery of hydronephrosis were compared between the two groups.Results:The operation time in laparoscopic group was shorter than that in percutaneous nephroscopy group[(50.3±11.1)min vs.(78.5 +16.8)min];the amount of intraoperative bleeding in laparoscopic group[(15.5±2.7)mL]was less than that in percutaneous nephroscopy group[(89.4±20.6)mL];there was no significant difference in stone clearance rate between the two groups;complications occurred in 38 cases of laparoscopic group,and 29 cases in percutaneous nephroscopy group. The incidence of pain in laparoscopic group(92.7%)was higher than that in percutaneous nephroscopy group(25.4%). The incidence of postoperative infection and perirenal hematoma in percutaneous nephroscopy group was23.3% and 18.6% respectively,which was higher than that in laparoscopic group. The postoperative hospital stay in laparoscopic group and percutaneous nephroscopy group was(8.1±0.7)days and(6.8±2.3)days,and there was no significant difference between the two groups(P>0.05). There was no significant difference in the recovery of hydronephrosis between the two groups at 3 rd month after operation.Conclusion:As compared with the microchannel percutaneous nephrolithotomy in the treatment of upper ureteral calculi,the laparoscopic group had shorter operation time,less bleeding and fewer serious complications,but the incision pain was obvious after operation.
Objective:To compare the clinical efficacy of transabdominal laparoscopy and microchannel percutaneous nephroscopy in the treatment of upper ureteral calculi.Methods:From March 2016 to January 2018,84 patients with upper ureteral calculi were retrospectively analyzed. Laparoscopic transabdominal ureterolithotomy was performed on 41 patients. Microchannel percutaneous nephrolithotomy with holmium laser lithotripsy was performed on 43 patients. The operation time,intraoperative blood loss,stone clearance rate,postoperative complications,hospitalization time and recovery of hydronephrosis were compared between the two groups.Results:The operation time in laparoscopic group was shorter than that in percutaneous nephroscopy group[(50.3±11.1)min vs.(78.5 +16.8)min];the amount of intraoperative bleeding in laparoscopic group[(15.5±2.7)mL]was less than that in percutaneous nephroscopy group[(89.4±20.6)mL];there was no significant difference in stone clearance rate between the two groups;complications occurred in 38 cases of laparoscopic group,and 29 cases in percutaneous nephroscopy group. The incidence of pain in laparoscopic group(92.7%)was higher than that in percutaneous nephroscopy group(25.4%). The incidence of postoperative infection and perirenal hematoma in percutaneous nephroscopy group was23.3% and 18.6% respectively,which was higher than that in laparoscopic group. The postoperative hospital stay in laparoscopic group and percutaneous nephroscopy group was(8.1±0.7)days and(6.8±2.3)days,and there was no significant difference between the two groups(P>0.05). There was no significant difference in the recovery of hydronephrosis between the two groups at 3 rd month after operation.Conclusion:As compared with the microchannel percutaneous nephrolithotomy in the treatment of upper ureteral calculi,the laparoscopic group had shorter operation time,less bleeding and fewer serious complications,but the incision pain was obvious after operation.
引文
[1] JUAN YS,SHEN JT,LI CC. Comparison of percutaneous nephrolithotomy and ureteroscopic lithotripsy in management of impacted,large,proximal ureteral stones. Kaohsiung J Med Sci,2008,24(4):204-209.
[2] QIAO P,ZHANG J,WANG J,et al. Retroperitoneal laparoendoscopic single-site ureterolithotomy versus conventional laparoscopic ureterolithotomy.Chin Med J(Engl),2014,127(5):865-868.
[3]马海,李杨,周文奇,等.输尿管软镜钬激光碎石术治疗上尿路结石(附86例报告).中国微创外科杂志,2017,17(6):565-567.
[4]邓青富,朱永生,裴利军,等.术前预置D-J管对输尿管软镜碎石的影响.重庆医学,2015,44(32):4502-4503.
[5] WANG JE,ZHANG XB,ZHANG TD,et al. The role of solifenacin,as monotherapy or combination with tamsulosin in ureteral stent-related symptoms:a systematic review and meta-analysis. World J Urol,2017,35(11):1669-1680.
[6]那彦群,孙光.中国泌尿外科疾病诊断治疗指南.北京:人民卫生出版社,2013:209-271.
[7] YAMAGUCHI A,SKOLARIKOS A,BUCHHOLZ NP,et al. Operating times and bleeding complications in percutaneous nephrolithotomy:a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol,2011,25(6):933-939.
[8]陆明,热吾力,伊力夏提,等.X线辅助B超引导经皮肾镜治疗无积水肾结石.广东医学,2015,36(15):2393-2394.
[9]钟羽翔,麦源,黄剑华,等.两种路径腹腔镜输尿管切开取石术的比较.中国微创外科杂志,2017,17(8):707-709.
[10] TURK C,NEISIUS A,SARICA K,et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol,2016,69(3):468-474.
[11] SENOCAK C,OZBEK R,BOZKURT OF,et al.Predictive factors of bleeding among pediatric patients undergoing percutaneous nephrolithotomy.Urolithiasis,2018,46(4):383-389.
[12]吴铁球,汪志民,唐智旺,等.经皮肾镜与后腹腔镜治疗输尿管上段嵌顿结石的疗效比较.临床泌尿外科杂志,2013,28(1):22-25.
[13]廖勇,李康,黄建林,等.不同手术方式治疗复杂性输尿管上段结石的疗效比较.昆明医科大学学报,2014,35(2):73-76.
[14] JIANG HY,YU Z,CHEN LP,et al. Minimally invasive percutaneous nephrolithotomy versus retrograde intrarenal surgery for upper urinary stones:a systematic review and meta-analysis. Biomed Res Int,2017,2017:2035851.
[15]李健,王健,李应忠,等.经尿道输尿管软镜碎石与微创经皮肾镜取石治疗肾盏结石的对比研究.昆明医科大学学报,2015,36(3):134-136.
[16]缪惠东,何中寅,沈锋,等.三种微创手术治疗输尿管上段结石疗效观察.山东医药,2015,55(28):76-77.
[17]王亚园,许长宝,褚校涵,等.超微经皮肾镜与输尿管软镜治疗直径2-3cm高CT值肾结石疗效比较.实用医学杂志,2018,34(13):2181-2184.
[18] CUI Z,GAO Y,YANG W,et al. Therapeutic effects of visual standard channel combined with F4. 8visual puncture super-mini percutaneous nephrolithotomy on multiple renal calculi. Pak J Med Sci,2018,34(1):110-114.
[19]杨峻峰,肖民辉,何正宇,等.经脐单孔腹腔镜输尿管及肾盂切开取石术18例临床分析.第三军医大学学报,2017,39(1):95-100.
[2] QIAO P,ZHANG J,WANG J,et al. Retroperitoneal laparoendoscopic single-site ureterolithotomy versus conventional laparoscopic ureterolithotomy.Chin Med J(Engl),2014,127(5):865-868.
[3]马海,李杨,周文奇,等.输尿管软镜钬激光碎石术治疗上尿路结石(附86例报告).中国微创外科杂志,2017,17(6):565-567.
[4]邓青富,朱永生,裴利军,等.术前预置D-J管对输尿管软镜碎石的影响.重庆医学,2015,44(32):4502-4503.
[5] WANG JE,ZHANG XB,ZHANG TD,et al. The role of solifenacin,as monotherapy or combination with tamsulosin in ureteral stent-related symptoms:a systematic review and meta-analysis. World J Urol,2017,35(11):1669-1680.
[6]那彦群,孙光.中国泌尿外科疾病诊断治疗指南.北京:人民卫生出版社,2013:209-271.
[7] YAMAGUCHI A,SKOLARIKOS A,BUCHHOLZ NP,et al. Operating times and bleeding complications in percutaneous nephrolithotomy:a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol,2011,25(6):933-939.
[8]陆明,热吾力,伊力夏提,等.X线辅助B超引导经皮肾镜治疗无积水肾结石.广东医学,2015,36(15):2393-2394.
[9]钟羽翔,麦源,黄剑华,等.两种路径腹腔镜输尿管切开取石术的比较.中国微创外科杂志,2017,17(8):707-709.
[10] TURK C,NEISIUS A,SARICA K,et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol,2016,69(3):468-474.
[11] SENOCAK C,OZBEK R,BOZKURT OF,et al.Predictive factors of bleeding among pediatric patients undergoing percutaneous nephrolithotomy.Urolithiasis,2018,46(4):383-389.
[12]吴铁球,汪志民,唐智旺,等.经皮肾镜与后腹腔镜治疗输尿管上段嵌顿结石的疗效比较.临床泌尿外科杂志,2013,28(1):22-25.
[13]廖勇,李康,黄建林,等.不同手术方式治疗复杂性输尿管上段结石的疗效比较.昆明医科大学学报,2014,35(2):73-76.
[14] JIANG HY,YU Z,CHEN LP,et al. Minimally invasive percutaneous nephrolithotomy versus retrograde intrarenal surgery for upper urinary stones:a systematic review and meta-analysis. Biomed Res Int,2017,2017:2035851.
[15]李健,王健,李应忠,等.经尿道输尿管软镜碎石与微创经皮肾镜取石治疗肾盏结石的对比研究.昆明医科大学学报,2015,36(3):134-136.
[16]缪惠东,何中寅,沈锋,等.三种微创手术治疗输尿管上段结石疗效观察.山东医药,2015,55(28):76-77.
[17]王亚园,许长宝,褚校涵,等.超微经皮肾镜与输尿管软镜治疗直径2-3cm高CT值肾结石疗效比较.实用医学杂志,2018,34(13):2181-2184.
[18] CUI Z,GAO Y,YANG W,et al. Therapeutic effects of visual standard channel combined with F4. 8visual puncture super-mini percutaneous nephrolithotomy on multiple renal calculi. Pak J Med Sci,2018,34(1):110-114.
[19]杨峻峰,肖民辉,何正宇,等.经脐单孔腹腔镜输尿管及肾盂切开取石术18例临床分析.第三军医大学学报,2017,39(1):95-100.