腹腔镜手术在治疗合并输尿管狭窄的输尿管上段结石中的临床应用

王俊+刘方+易睿

[摘要]目的 探讨腹腔镜手术治疗输尿管上段结石合并输尿管狭窄的临床效果。方法 选择2010年1月～2016年6月我院收治的36例输尿管上段结石合并输尿管狭窄患者作为研究对象，随机分为观察组和对照组，各18例。观察组采用腹腔镜取石手术，对照组采用经皮肾镜手术。记录两组的手术时间、住院时间及术后镇痛药物使用时间，比较两组的临床效果及术后并发症发生率。结果 观察组的手术时间、术后镇痛药物使用时间显著短于对照组，差异有统计学意义（P<0.05）。两组的住院时间比较，差异无统计学意义（P>0.05）。两组的结石清除率及不良反应发生率比较，差异无统计学意义（P>0.05）。结论 腹腔镜手术治疗合并输尿管狭窄的输尿管上段结石可显著缩短患者治疗后的康复时间，且不良反应发生率较低，具有显著的临床优势。

[关键词]腹腔镜技术；经皮肾镜手术；输尿管狭窄；输尿管上段结石

[中图分类号] R693+.4 [文献标识码] A [文章编号] 1674-4721（2016）12（a）-0047-03

Clinical application of laparoscopic surgery in the treatment of upper ureteral calculi complicated with ureteral stricture

WANG Jun LIU Fang YI Rui

Department of Urology Surgery，People′s Hospital of Pingxiang City in Jiangxi Province，Pingxiang 337000，China

[Abstract]Objective To explore the clinical effect of laparoscopic surgery in the treatment of upper ureteral calculi complicated with ureteral stricture.Methods 36 patients with upper ureteral calculi and ureteral stricture in our hospital from January 2010 to June 2016 were selected and randomly divided into the observation group and the control group，18 cases in each group.The observation group was treated with laparoscopic surgery，the control group was treated by percutaneous renal surgery.The operation time，length of stay，and postoperative analgesic use time in the two groups were recorded，the clinical effect and the incidence rate of postoperative complications were compared between the two groups.Results The operation time，postoperative analgesic use time of the observation group was shorter than that of the control group，with significant difference （P<0.05）.There was no significant difference in the length of stay between the two groups （P>0.05）.The calculi clearance rate and the incidence rate of adverse reactions in the two groups were compared，the difference was not statistically significant （P>0.05）.Conclusion Laparoscopic surgery in the treatment of upper ureteral calculi with ureteral stenosis can significantly reduce the recovery time of patients after treatment，which has a low incidence of adverse reactions，with significant clinical advantages.

[Key words]Laparoscopic technique；Percutaneous nephrolithotomy surgery；Ureteral stricture；Upper ureteral calculi

輸尿管结石（尤其是输尿管上段结石）是常见的泌尿外科疾病之一[1-2]。近年来，由于生活节奏不断加快、药物滥用情况愈发增加等因素的影响，输尿管结石的发病率显著上升[3-5]。在所有输尿管结石发病患者中，80%的患者的结石可自然排出（输尿管狭窄患者不包括其中），因此，输尿管上段结石合并输尿管狭窄的患者临床治疗较为困难，已成为目前研究的热点问题之一[6]。作为一门新发展起来的微创方法，腹腔镜微创手术具有创伤小、术后并发症发生率低、恢复迅速等优点，同时可大大减少患者的负担和费用。近年来，随着腹腔镜手术治疗技术的成熟和推广，其在泌尿外科疾病中的应用也逐渐增加[7]，如肾囊肿切除术、隐睾的睾丸引降术、精索静脉高位结扎术等。有研究表明，腹腔镜手术亦可作为输尿管上段结石合并输尿管狭窄的治疗手段之一，且方法较为安全。本研究选取我院收治的输尿管上段结石合并输尿管狭窄患者作为研究对象，探讨腹腔镜手术的临床效果及安全性，现报道如下。1资料与方法