后腹腔镜与经皮肾镜术治疗输尿管上段结石的对比研究

目的比较后腹腔镜下输尿管切开取石术与经皮肾镜术治疗输尿管上段结石的手术疗效。方法将2012年10月至2014年4月收治的24例输尿管上段结石患者随机分为两组,12例使用后腹腔镜下输尿管切开取石术（RLU）治疗,12例使用经皮肾镜术（PCNL）治疗。比较两组的手术时间、术中出血量、清石率、术后2天疼痛评分、术后3天下床率。结果所有患者均取石成功,RLU组手术时间为（90.3±18.2）min,稍长于PCNL组的（85.2±19.6）min,但差异无统计学意义（P〉0.05）;术中出血量PCNL组为（92.4±10.6）ml,高于RLU组的（48.6±9.3）ml,差异有统计学意义（P〈0.01）;术后2天采用＂疼痛强度评分量表＂进行疼痛评分,RLU组为（3.0±0.6）分,显著低于PCNL组的（6.0±1.8）分,差异有统计学意义（P〈0.01）;术后3天下床率,RLU组为83.3%（10/12）,PCNL组为25.0%（3/12）,差异有统计学意义（P〈0.05）,术后1周摄KUB片,了解结石的清除率,RLU组为100%（12/12）,PCNL组为91.6%（11/12）,差异无统计学意义（P〉0.05）。术后随访3～16个月,平均8个月,未见输尿管狭窄和输尿管结石复发。结论 PCNL与RLU在治疗输尿管上段结石上都具有满意的疗效与安全性,RLU术中出血较少,对肾无损伤,一次性结石的清除率高,术后恢复较PCNL快,在有条件的医院,医生技术成熟,RLU可适当开展,可作为治疗输尿管上段结石的首选方法。

Comparation study of retroperitoneal laparoscopic ureterolithotomy and percutaneous nephrolithotomy for proximal ureteral calculus

Objective To compare the efficacy of retroperitoneal laparoscopy and percutaneous nephrolithotomy in the treatment of upper ureteral calculi. Methods 24 cases with upper ureteral calculi admitted to hospital from October,2012 to April,2014 were randomly divided into two groups with 12 cases in each group. One group（ RLU group） underwent retroperitoneal laparoscopic ureterolithotomy（ RLU）,and the other group（ PCNL group） underwent percutaneous nephrostolithotomy（ PCNL）. Then,their operative time,amount of bleeding during operation,stone clearance rate,pain score two days later after operation,rate of leaving bed three days later after operation were compared. Results Stones of all patients were successfully removed by operation. The operation time of the RLU group was（ 90. 3 ± 18. 2） min,slightly longer than that（ 85. 2 ± 19. 6）min of the PCNL group,but the difference was not statistically significant（ P〉0. 05）; the amount of bleeding during operation of the PCNL group was（ 92. 4 ± 10. 6） ml,significantly higher than that（ 48. 6 ± 9. 3） ml of the RLU group,so the difference was statistically significant（ P〈0. 01）. The rating scale of pain intensity was taken to measure the score of pain two days later after the operation,and the pain score of the RLU group was（ 3. 0 ± 0. 6） points,significantly lower than that（ 6. 0± 1. 8） points of the PCNL group,so the difference was statistically significant（ P〈0. 01）. The rate of leaving bed three days later after operation in the RLU group was 83. 3%（ 10 /12）,and that of the PCNL group was 25. 0%（ 3 /12）,so the difference was statistically significant（ P〈0. 05）. KUB was taken to reveal the stone clearance rate one week later after operation,which showed that of the RLU group was 100%（ 12 /12）,and that of the PCNL group was 91. 6%（ 11 /12）,so the difference was not statistically significant（ P〉0. 05）. All patients were followed up for 3 to 16 months with an average of 8 months,which ind