中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
8期
21-23
,共3页
输尿管结石%碎石术%腹腔镜
輸尿管結石%碎石術%腹腔鏡
수뇨관결석%쇄석술%복강경
Uretoral calculi%Lithotripsy%Laparoscopes
目的 探讨三种微创手术方法治疗输尿管上段结石合并不同程度肾积水的有效性及适应证.方法 回顾性分析492例输尿管上段结石合并不同程度肾积水患者的临床资料,分别行微创经皮肾镜取石术(mPCNL)(mPCNL组,310例)、输尿管镜气压弹道碎石术(URSL)(URSL组,130例)及后腹腔镜输尿管切开取石术( RLU)(RLU组,52例).对比三组患者的手术时间、术中出血量、住院时间、结石清除率及术后并发症发生率.结果 mPCNL组结石清除率为91.0％(282/310),URSL组为78.5％(102/130),RLU组为100.0％ (52/52),mPCNL组和RLU组结石清除率明显高于URSL组(P＜0.01),而RLU、URSL组的手术时间、术中出血量、住院时间及术后并发症发生率则明显少于mPCNL组[RIU组:(55.8±20.5) min、( 10.8±3.2) ml、(6.3±2.1)d、1.9％(1/52),URSL组:(56.5±15.2) min、(8.6±1.4)ml、(5.7±1.6)d、1.5％( 2/130),mPCNL组:(113.8±42.5) min、(132.8±40.2) ml、( 12.5±2.4)d、8.4％(26/310),P＜0.01].结论 微创手术治疗输尿管上段结石是安全有效的,输尿管上段小结石首选URSL,对于较大的结石RLU可提高手术成功率,若同时合并有肾结石,则选用mPCNL.mPCNL结石清除率高,可作为URSL治疗失败后的补充.
目的 探討三種微創手術方法治療輸尿管上段結石閤併不同程度腎積水的有效性及適應證.方法 迴顧性分析492例輸尿管上段結石閤併不同程度腎積水患者的臨床資料,分彆行微創經皮腎鏡取石術(mPCNL)(mPCNL組,310例)、輸尿管鏡氣壓彈道碎石術(URSL)(URSL組,130例)及後腹腔鏡輸尿管切開取石術( RLU)(RLU組,52例).對比三組患者的手術時間、術中齣血量、住院時間、結石清除率及術後併髮癥髮生率.結果 mPCNL組結石清除率為91.0％(282/310),URSL組為78.5％(102/130),RLU組為100.0％ (52/52),mPCNL組和RLU組結石清除率明顯高于URSL組(P＜0.01),而RLU、URSL組的手術時間、術中齣血量、住院時間及術後併髮癥髮生率則明顯少于mPCNL組[RIU組:(55.8±20.5) min、( 10.8±3.2) ml、(6.3±2.1)d、1.9％(1/52),URSL組:(56.5±15.2) min、(8.6±1.4)ml、(5.7±1.6)d、1.5％( 2/130),mPCNL組:(113.8±42.5) min、(132.8±40.2) ml、( 12.5±2.4)d、8.4％(26/310),P＜0.01].結論 微創手術治療輸尿管上段結石是安全有效的,輸尿管上段小結石首選URSL,對于較大的結石RLU可提高手術成功率,若同時閤併有腎結石,則選用mPCNL.mPCNL結石清除率高,可作為URSL治療失敗後的補充.
목적 탐토삼충미창수술방법치료수뇨관상단결석합병불동정도신적수적유효성급괄응증.방법 회고성분석492례수뇨관상단결석합병불동정도신적수환자적림상자료,분별행미창경피신경취석술(mPCNL)(mPCNL조,310례)、수뇨관경기압탄도쇄석술(URSL)(URSL조,130례)급후복강경수뇨관절개취석술( RLU)(RLU조,52례).대비삼조환자적수술시간、술중출혈량、주원시간、결석청제솔급술후병발증발생솔.결과 mPCNL조결석청제솔위91.0％(282/310),URSL조위78.5％(102/130),RLU조위100.0％ (52/52),mPCNL조화RLU조결석청제솔명현고우URSL조(P＜0.01),이RLU、URSL조적수술시간、술중출혈량、주원시간급술후병발증발생솔칙명현소우mPCNL조[RIU조:(55.8±20.5) min、( 10.8±3.2) ml、(6.3±2.1)d、1.9％(1/52),URSL조:(56.5±15.2) min、(8.6±1.4)ml、(5.7±1.6)d、1.5％( 2/130),mPCNL조:(113.8±42.5) min、(132.8±40.2) ml、( 12.5±2.4)d、8.4％(26/310),P＜0.01].결론 미창수술치료수뇨관상단결석시안전유효적,수뇨관상단소결석수선URSL,대우교대적결석RLU가제고수술성공솔,약동시합병유신결석,칙선용mPCNL.mPCNL결석청제솔고,가작위URSL치료실패후적보충.
Objective To explore the efficacy and indications of three kinds minimally invasive surgery treatment of upper ureteral calculus (UUC) complicating hydronephrosis.Methods Four hundred and ninety-two patients with UUC complicating hydronephrosis were divided into three groups:minimally percutaneous nephrolithotomy (mPCNL) group (310 patients),ureteroscopy lithotripsy(URSL) group ( 130 patients) and retroperitoneal laparoscopic ureterolithotomy (RLU) group (52 patients).The operation time,blood loss,length of stay,stone-free rate and postoperative complications in three groups were compared.Results The stone-free rate was 91.0％(282/310) in mPCNL group,78.5％(102/130) in URSL group and 100.0％(52/52) in RLU group,mPCNL group and RLU group were significantly higher than URSL group (P ＜0.01 ).URSL group and RLU group had the advantage of less operation time,blood loss,length of stay and postoperative complications compared with mPCNL group [ RLU group:(55.8 ± 20.5 ) min,( 10.8 ± 3.2)ml,(6.3 ± 2.1 ) d,1.9％(1/52) ;URSL group:(56.5 ± 15.2) min,(8.6 ± 1.4) ml,(5.7 ± 1.6) d,1.5％(2/130);mPCNL group:(113.8 ±42.5) min,(132.8 ±40.2) ml,(12.5 ±2.4) d,8.4％(26/310),P＜ 0.01 ].Conclusions Minimally invasive surgery on the treatment of UUC is safe and effective.URSL is preferred to treating the small UUC,RLU can improve the success rate for larger UUC.Contrary to mPCNL,which is best for merger kidney calculus,has higher stone-free rate,can be used as supplement of URSL after treatment failure.
