CAJ | 학술논문

目的通过比较输尿管镜钬激光碎石及腹腔镜下输尿管切开取石治疗输尿管结石的效果及并发症来探索治疗输尿管结石的最佳手术方案及手术技巧.方法 60例单侧输尿管结石患者被随机分成两组,一组是在全麻下行腹腔镜下输尿管切开取石术(n＝30),另一组是在硬膜外麻下行输尿管镜钬激光碎石术(n=30),术中两组常规放置双J管,通过对该60例患者的临床数据总结,比较两组患者的手术时间、住院时间、结石清除率及并发症.结果输尿管钬激光碎石组有1例患者术中转开放,其余59例均顺利完成手术,输尿管镜钬激光碎石和腹腔镜输尿管切开取石的手术时间分别是:(52.0±l0.7)min和(68.6±8.0)min,住院时间是:(3.8±1.3)天和(4.7±0.8)天；结石清除率是:87％和100％,输尿管镜钬激光碎石组有4例患者出现结石上移至肾盂,术后通过体外震波碎石治疗,有2例患者术后出现发热,经加强抗感染后恢复,有2例患者在随访期间出现输尿管狭窄,经输尿管镜下行狭窄内切开并防止双J管后恢复,所有患者随访时间为6～24个月.结论腹腔镜输尿管切开取石术在治疗输尿管大的结石时相比输尿管镜钬激光碎石有更高的结石清除率及更少的手术并发症,我们的经验提示腹腔镜输尿管切开取石是治疗输尿管结石安全有效的手术方法.
목적 통과비교수뇨관경화격광쇄석급복강경하수뇨관절개취석치료수뇨관결석적효과급병발증래탐색치료수뇨관결석적최가수술방안급수술기교.방법 60례단측수뇨관결석환자피수궤분성량조,일조시재전마하행복강경하수뇨관절개취석술(n＝30),령일조시재경막외마하행수뇨관경화격광쇄석술(n=30),술중량조상규방치쌍J관,통과대해60례환자적림상수거총결,비교량조환자적수술시간、주원시간、결석청제솔급병발증.결과 수뇨관화격광쇄석조유1례환자술중전개방,기여59례균순리완성수술,수뇨관경화격광쇄석화복강경수뇨관절개취석적수술시간분별시:(52.0±l0.7)min화(68.6±8.0)min,주원시간시:(3.8±1.3)천화(4.7±0.8)천；결석청제솔시:87％화100％,수뇨관경화격광쇄석조유4례환자출현결석상이지신우,술후통과체외진파쇄석치료,유2례환자술후출현발열,경가강항감염후회복,유2례환자재수방기간출현수뇨관협착,경수뇨관경하행협착내절개병방지쌍J관후회복,소유환자수방시간위6～24개월.결론 복강경수뇨관절개취석술재치료수뇨관대적결석시상비수뇨관경화격광쇄석유경고적결석청제솔급경소적수술병발증,아문적경험제시복강경수뇨관절개취석시치료수뇨관결석안전유효적수술방법.
Objective To explore the optimal surgical procedures and skills by comparing the efficacy of ureteroscopic holmium laser lithotripsy with that of laparoscopic ureterolithotomy for unilateral ureteral stones.Methods Sixty patients with unilateral ureteral stones were randomly assigned to receive laparoscopic ureterolithotomy under general anesthesia (n=30),or ureteroscopic holmium laser lithotripsy under epidural or lumbar anesthesia (n＝30).Double-J stent was routinely placed in both groups.Surgical duration,length of hospital stay,stone clearance rate,and rate of perioperative complications were compared.Results Ureteroscopic holmium laser lithotripsy was successfully performed on 59 patients,and one patient needed to received open surgery intraoperatively.The mean surgical duration was (52.0 ± 10.7)min in ureteroscopic lithotripsy group and (68.6 ± 8.0)min in laparoscopic ureterolithotomy (P＜0.01); length of hospital stay was (3.8 ± 1.3)days and (4.7 ± 0.8)days (P＜0.01); and stone clearance rate was 87％ and 100％,respectively.In ureteroscopic lithotripsy group,stones moved to the renal pelvis in 4 patients,and the residual stones were removed by extracorporeal shock-wave lithotripsy (ESWL).2 patients developed fever and recovered after anti-infective therapy.All patients were followed up for 6 to 24 months.Ureterostensis occurred in 2 patients during follow-up,and recovered after ureteroscopic urethrotomy was performed and 2 double-J catheters were placed for 3 months.Conclusions Laparoscopic ureterolithotomy has a higher stone clearance rate and fewer complications as compared with ureteroscopic holmium laser lithotripsy.Laparoscopic ureterolithotomy is a safe,effective procedure for ureteral stones.