摘要
目的探讨三种微创术式治疗输尿管上段复杂性结石疗效及对肾功能、术后疼痛的影响。方法回顾性分析我院2017年1月~2022年5月97例输尿管上段复杂性结石患者的临床资料,根据手术方式不同分为腹腔镜下输尿管切开取石术(RLU)组(42例)、微造瘘经皮肾镜碎石取石术(MPCNL)组(15例)、输尿管镜碎石术(URL)组(40例)。比较3组围术期指标、手术前后肾功能[尿素氮(BUN)、脂质运载蛋白(NGAL)、血肌酐(Scr)]、疼痛程度、并发症。结果RLU组手术时间长于URL组及MPCNL组,术中出血量低于URL组及MPCNL组,住院时间短于URL组及MPCNL组,一次结石清除率高于URL组及MPCNL组(均P<0.05);3组术后Scr、BUN水平比较,差异无统计学意义(P>0.05);RLU组术后血清NGAL水平低于URL组及MPCNL组(P<0.05);MPCNL组术后1、3 d视觉疼痛模拟评分(VAS)高于URL组及RLU组(P<0.05);RLU组并发症发生率低于URL组及MPCNL组(P<0.05)。结论RLU、MPCNL、URL均可用于输尿管上段复杂性结石的治疗,其中RLU术中出血量少、术后恢复时间短、一次结石清除率高、术后并发症少,能保护肾功能,可作为首选治疗手段;MPCNL手术创伤稍大,对同侧肾结石及肾盂输尿管连接部狭窄的患者,可作为一期手术治疗,住院周期较长;URL术后疼痛程度最低,可能更适合对疼痛敏感的患者。
Objective To explore the curative effect of three minimally invasive surgery on complex proximal ureteral calculi and their influences on renal function and postoperative pain.Methods A retrospective analysis was performed on the clinical data of 97 patients with complex proximal ureteral calculi in the hospital from January 2017 to May 2022.According to different surgical methods,they were divided into retroperitoneal laparoscopic ureterolithotomy(RLU)group(42 cases),mini-percutaneous nephrolithotomy(MPCNL)group(15 cases)and transurethral ureteroscopic lithotripsy(URL)group(40 cases).The perioperative indexes,renal function indexes[blood urea nitrogen(BUN),lipocalin(NGAL),serum creatinine(Scr)],pain level and complications before and after surgery were compared among the three groups.Results The operation time in RLU group was longer than that in URL group and MPCNL group,intraoperative blood loss was lower than that in URL group and MPCNL group,hospitalization time was shorter than that in URL group and MPCNL group,and one-time stone clearance rate was higher than that in URL group and MPCNL group(P<0.05).There was no significant difference in postoperative Scr or BUN among the three groups(P>0.05).After surgery,level of serum NGAL in RLU group was lower than that in URL group and MPCNL group(P<0.05).At 1d and 3d after surgery,scores of Visual Analogue Scale(VAS)in MPCNL group were higher than those in URL group and RLU group(P<0.05).The incidence of complications in RLU group was lower than that in URL group and MPCNL group(P<0.05).Conclusion RLU,MPCNL and URL can all be applied in the treatment of complex proximal ureteral calculi.Among them,RLU has little intraoperative blood loss,short postoperative recovery time,high one-time stone clearance rate and few postoperative complications,which can protect renal function and is the first choice.MPCNL has more surgical trauma and can be the one-stage operation for patients with ipsilateral nephrolithiasis and ureteropelvic junction stenosis,with long hospitalization time.URL has the mildest postoperative pain,which may be more suitable for patients with pain sensitivity.
作者
王世伟
徐雪峰
赵学良
马锐
马良丰
谷永金
WANG Shiwei;XU Xuefeng;ZHAO Xueliang;MA Rui;MA Liangfeng;GU Yongjin(Department of Urology,Bozhou Hospital of Traditional Chinese Medicine,Bozhou 236800,Anhui,China)
出处
《西部医学》
2023年第2期238-241,246,共5页
Medical Journal of West China
基金
安徽中医药大学科研基金项目(2021LCBZ15)。
