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输尿管结石是常见疾病,其中嵌顿性结石占大多数,输尿管上段嵌顿性结石主要发生在第四腰椎下缘以上,一般结石停留时间较长,其主要症状是肾积水明显,影响肾功能,对肾脏损伤极大[1]。
输尿管上段嵌顿性结石通常与输尿管黏膜粘连,同时可能被包裹在息肉中,治疗难度较大,传统冲击波碎石治疗效果不明显[2],而开放性手术治疗造成创伤较大,恢复较慢[3]。
随着微创技术广泛应用于医疗,适用于嵌顿性输尿管上段结石的微创手术较多,如输尿管镜碎石、微通道经皮肾穿刺碎石术、腹腔镜下输尿管切开取石术,不同手术方式DOI:10.16662/ki.1674-0742.2021.02.026三种微创术式治疗嵌顿性输尿管上段结石的临床对照研究李柏林,姚铭,葛长官,李喆莱钢医院泌尿外科,山东济南271126[摘要]目的探究对嵌顿性输尿管上段结石患者采取三种微创术式的治疗效果。
方法随机选取该院自2018年6月—2020年1月期间收治的109例嵌顿性输尿管上段结石患者采取抽签法随机分为A、B、C3组,A组、B组各纳入42例,C组纳入25例,A组实施输尿管镜碎石,B组实施微通道经皮肾穿刺碎石术,C组实施腹腔镜下输尿管切开取石术,对比3组患者一次性结石清除率及并发症发生情况。
结果C组患者结石清除率高于B组,差异有统计学意义(χ2= 5.316,P=0.021),C组与B组结石清除率高于A组,差异有统计学意义(χ2=7.724、4.525,P<0.05);A组并发症发生率为21.43%对比B组的19.05%差异无统计学意义(χ2=0.074,P=0.786),A组并发症发生率对比C组的24.00%差异无统计学意义(χ2=0.060,P=0.807),B组并发症发生率对比C组差异无统计学意义(χ2=0.233,P=0.630)。
结论3种微创术式用于治疗嵌顿性输尿管上段结石均有疗效,各有优势,安全性无差异,可根据患者基本情况选择手术方式。
[关键词]嵌顿性输尿管上段结石;输尿管镜;微通道经皮肾穿刺碎石术;腹腔镜下输尿管切开取石术[中图分类号]R5[文献标识码]A[文章编号]1674-0742(2021)01(b)-0026-03A Clinical Controlled Study of Three Minimally Invasive Procedures for the Treatment of Incarcerated Upper Ureteral CalculiLI Bo-lin,YAO Ming,GE Chang-guan,LI ZheDepartment of Urology,Laigang Hospital,Jinan,Shandong Province,271126China[Abstract]Objective To explore the effects of three minimally invasive procedures for patients with incarcerated upper ureteral calculi.Methods109patients with incarcerated upper ureteral calculi admitted to the hospital from June2018to January2020were randomly selected randomly divided into three groups A,B,and C by lottery,with42cases in each group A and B included25cases were included in group C,group A was given ureteroscopic lithotripsy,group B was given microchannel percutaneous nephrolithotomy,and group C was given laparoscopic ureterectomy and pare the one-time stone clearance rate and complications occurrence.Results The stone clearance rate of group C was higher than that of group B,and the difference was statistically significant(χ2=5.316,P=0.021).The stone clearance rate of group C and B was higher than that of group A,and the difference was statistically significant(χ2=7.724,4.525,P<0.05);the complication rate of group A was21.43%compared to19.05%of group B was meaningless,and the difference was not statistically significant(χ2=0.074,P=0.786),and the complication rate of group A was compared with24.00%of group C,and the difference was not statistically significant(χ2=0.060,P=0.807),the complication rate of group B was compared to C group, and the difference was not statistically significant(χ2=0.233,P=0.630).Conclusion The three minimally invasive procedures for the treatment of incarcerated upper ureteral calculi have curative effects,each has advantages and no difference in safety.The surgical method can be selected according to the basic condition of the patient.[Key words]Incarcerated upper ureteral calculi;Ureteroscopy;Microchannel percutaneous nephrolithotomy;Laparoscopic ureterectomy and lithotripsy[作者简介]李柏林(1982-),男,硕士,主治医师,研究方向为泌尿外科。
