腹腔镜技术治疗上尿路结石的初步研究.docxVIP

腹腔镜技术治疗上尿路结石的初步研究 李立宇 陶志兴 何昊阳崔同芳 王卫生 谢波涛 云南省曲靖市第二人民医院泌尿外科 摘要： 目的 探求合理的处理上尿路结石的个体化治疗方案。方法2013年1月-2016 年6月，对具有一定特点的上尿路结石患者147例(侧)进行腹腔镜下取石或相 应手术治疗。就I期结石清除率、术中术后输血例数、术后介入止血例数、术后 发热(238°C)例数、术后重症感染例数、术后狭窄、平均住院时间和平均治疗 费用指标与2016年6月前的结石位置、形态、负荷分别相近、例(侧)数相当、 行经皮肾镜取石术(PCNL)及输尿管镜钦激光碎石术(URSL)的147例(侧) 患者的治疗结果进行比较。结果 腹腔镜组I期结石清除率100. 00% (147/147), 明显高于PCNL及URSL组91.84% (135/147),差异有统计学意义(P=0. 001); 腹腔镜组无术中术后输血(0/147)、介入止血(0/147),明显低于PCNL及 URSL组的6例(6/147)和4例(4/147),差异均有统计学意义(P=0. 013和 P二0.044);腹腔镜组无术后重症感染发牛(0/147) , PCNL及URSL组发牛术后 重症感染2例(2/147),差异无统计学意义(P二0.156);腹腔镜组术前体温正 常134例，术后发热(238°C) 9例(9/134),明显低于PCNL及URSL组28例 (28/147),差异有统计学意义(P二0.002);腹腔镜组术后尿路狭窄3例 (3/114),明显低于PCNL及URSL组的9例(9/101),差异有统计学意义 (P=0. 045);腹腔镜组平均住院时间(10. 12±0. 29) d,明显低于PCNL及URSL 组的(13. 79±0, 38) d,差异有统计学意义(P-0.011);腹腔镜组平均治疗费用 (12 514. 84±181.54)元，明显低于PCNL及URSL组的(18 124. 65±302, 32)元, 差异有统计学意义(P=0?018)。结论某些情况下，当上尿路结石适合“切开取 出”时，利用腹腔镜技术处理更为安全;当同时存在需要手术处理的合并症或并 发症时，可同时处理。腹腔镜技术是上尿路结石微创治疗的重要方法之一。 关键词： 腹腔镜技术;治疗;上尿路结石;应用研究; 收稿日期：2017-04-06 Preliminary application of laparoscopic technique in treatment of upper urinary calculi Li-yu Li Zhi~xing Tao Hao~yang He Tong-fang Cui Wei-sheng Wang Bo-tao Xie Department of Urology, the Second Peoples Hospital; Abstract： Objective To evaluate the reasonable individual program for upper urinary tract calculi in minimally invasive t rea tmen t. Met hods From January 2013 to June 2016, 147 patients (sides) with upper urinary calculi who had some characteristics received laparoscopic nehprectomy or corresponding surgical t rea tment. The number of cases of pos to pera tive stag nation, the average hospitalization time emd the average cost of treatment were compared with those of 147 patients (lateral) who underwent PCNL and URSL with the similarity, shape and load of stones before June 2016, respectively. Results The removal rate of stage I was 100. 00% (147/147) differcncc was statistically group postoperative blood hemostasis (0/147) were and 4 cases (4/147) in PCNL andin laperrosc