体外冲击波碎石术失败后行经皮肾镜、腹腔镜、输尿管硬镜取石术的疗效比较:8年以上的单中心研究

摘要

目的 比较患者体外冲击波碎石术(ESWL)术后行腹腔镜下输尿管切开取石术(RLU)、输尿管镜取石术(URS)和经皮肾镜取石术(PCNL)的疗效和并发症.方法 回顾性分析2006年9月至2014年8月贵州医大附属医院行ESWL术后采用RLU(A组)、URS(B组)和PCNL(C组)3种微创手术方法治疗输尿管上段残石患者共651例资料.比较3组患者基本情况、手术效果及并发症.并采用修改后的Clavien-Dindo评分系统来评估并发症的严重程度.结果 RLU组手术成功率(100％)、清石率(100％)均高于URS、PCNL两组.URS组手术时间为(46±9.1)min,均短于RLU组(54±10.3)min、PCNL组(62±15.2)min.URS组出血量最少(12±5.1)mL.胃肠功能恢复时间RLU组(23±2.2)h,明显长于URS组(8±0.6)h和PCNL(11±4.3)h(P＜0.05),3组术后下床活动时间和止痛药的使用无显著差异(P＞0.05).PCNL组并发症发生率(21.9％)高于RLU组和URS组,RLU组没有严重并发症.RLU组术后有4例患者发热,明显低于URS组(24例)和PCNL组(21例).RLU组术后未出现尿脓毒血症,而URS组有11例、PCNL组有13例患者分别出现尿脓毒血症.结论 RLU是处理输尿管上段结石EWSL失败后一种更安全有效的微创手术方法.%Objective To compare the incidence of complications and efficacy of retroperitoneal laparoscopic ureterolithotomy (RLU),rigid ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) for patients who had experienced extracorporeal shock wave lithotripsy (ESWL) failure.Methods A total of 651 patients who underwent ESWL failure during Sept.2009 and Aug.2014 received RLU (group A),URS (group B) and PCNL (group C).The demographical information,outcomes and complications were compared among the three groups.The severity of complications was evaluated with modified Calvien-Dindo system.Results The operation success rate and stone-free rate reached 100％ in group A,which were higher than those in group B and C.The operation time of group B was (46±9.1) min,which was shorter than that of group A (54±10.3) min and group C (62± 15.2) min.Group B had the least amount of bleeding (12± 5.1) mL.The average gastrointestinal function recovery time was (23±2.2) h in group A,which was higher than that in group B (8±0.6) h and group C (11±4.3) h,(P＜0.05).There were no statistical differences in the mean time for exercise and the use of analgesics among the three groups (P＞0.05).The incidence rate of complications was 21.9％ in group C,which was the highest.No serious complication was observed in group A.Fever occurred in 4,24 and 21 cases in group A,B and C.Urosepsis occurred in 0,11 and 13 cases in group A,B and C.Conclusion RLU may be the most safe and effective minimally invasive method to treat proximal ureteral calculi after EWSL failure.