嵌顿性输尿管上段结石RLU、PCNL治疗的预后效果分析

目的 探讨腹腔镜输尿管切开取石(RLU)、经皮肾镜取石术(PCNL)两种方法治疗嵌顿性输尿管上段结石的临床效果.方法 选取本院201 1年1月至2015年9月泌尿外科治疗的133例嵌顿性输尿管上段结石患者进行回顾性分析,其中采用RLU治疗68例(RLU)组、采取PCNL治疗65例(PCNL)组,对比两种手术方法治疗的临床效果.结果 PCNL组患者的手术时间(31.6±5.7)min、术后住院时间(4.8±1.0)d均显著的低于RLU组(49.8±8.2) min、(7.2±1.5)d(P＜0.05),PCNL组患者的手术出血量(220.6±40.0) mL、住院费(20984±2237)元用均显著的高于RLU组(185.5 ±35.6) mL、(13098±1975)元(P＜0.05),PCNL组与RLU组的术后24h体温≥38℃患者比例、血红蛋白下降值、术后结石清除率差异均无统计学意义(P＞0.05).PCNL组患者术后第2、14、72h血清CRP水平(3.28±1.47) mg/L、(27.85±9.29) mg/L、(13.06±6.14) mg/L显著的低于RLU组患者(5.15±1.72) mg/L、(34.98±10.75) mg/L、(17.29±6.80)mg/L(P ＜0.05).PCNL组患者的手术并发症率18.46％(12/65)与RLU组患者的23.53％ (16/68)差异无统计学意义(P＞0.05).结论 RLU与PCNL两种方法治疗嵌顿性输尿管上段结石均具有较好的临床效果,但PCNL具有手术创伤小、时间短、术后患者恢复快的优势.

Prognostic effect of RLU and PCNL in the treatment of impacted upper ureteral calculi

Objectives To investigate the clinical effect of retroperitoneal laparoscopic ureterolithotomy (RLU) and percutaneous nephrolithotomy(PCNL) in the treatment of impacted upper urethral calculi.Methods 133 cases of impacted proximal urethral calculi were retrospectively analyzed in our hospital from January 2011 to September 2015.All patients were divided into RLU group (68 cases)and PCNL group(65 cases),and the effects of two groups were compared.Results The operation time of PCNL group (31.6 ±5.7) min,postoperative hospital stay (4.8 ± 1.0) d were significantly less than the RLU group (49.8 ± 8.2) min,(7.2 ± 1.5) d (P ＜ 0.05),bleeding volume of PCNL group (220.6 ± 40.0) mL,hospital expenses (20984 ± 2237) yuan were significantly higher than with RLU group (185.5 ±35.6) mL,(13098 ±1975) yuan (P ＜0.05).Proportion of patients with postoperative temperature(≥38℃),hemoglobin decreased value and stone clearance rate were no significant differences between the PCNL group and the RLU group(P ＞ 0.05).Serum CRP levels of PCNL group (3.28 ±1.47) mg/L,(27.85 ±9.29) mg/L,(13.06±6.14) mg/L were significantly less than RLU group (5.15 ± 1.72) mg/L,(34.98 ± 10.75) mg/L,(17.29 ±6.80) mg/L at 2,14,72 h (P ＜0.05).There was no difference in postoperative complications rate between PCNL group (18.46％) and RLU group (23.53％) (P ＞0.05).Conclusions RLU and PCNL in the treatment of impacted upper ureteral calculi have better clinical results,but PCNL has advantages of small incision,shorter operative time and quicker recovery.