腹腔鏡手術(shù)在治療合并輸尿管狹窄的輸尿管上段結(jié)石中的臨床應(yīng)用

王俊+劉方+易睿

[摘要]目的 探討腹腔鏡手術(shù)治療輸尿管上段結(jié)石合并輸尿管狹窄的臨床效果。方法 選擇2010年1月～2016年6月我院收治的36例輸尿管上段結(jié)石合并輸尿管狹窄患者作為研究對象，隨機(jī)分為觀察組和對照組，各18例。觀察組采用腹腔鏡取石手術(shù)，對照組采用經(jīng)皮腎鏡手術(shù)。記錄兩組的手術(shù)時(shí)間、住院時(shí)間及術(shù)后鎮(zhèn)痛藥物使用時(shí)間，比較兩組的臨床效果及術(shù)后并發(fā)癥發(fā)生率。結(jié)果 觀察組的手術(shù)時(shí)間、術(shù)后鎮(zhèn)痛藥物使用時(shí)間顯著短于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組的住院時(shí)間比較，差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。兩組的結(jié)石清除率及不良反應(yīng)發(fā)生率比較，差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 腹腔鏡手術(shù)治療合并輸尿管狹窄的輸尿管上段結(jié)石可顯著縮短患者治療后的康復(fù)時(shí)間，且不良反應(yīng)發(fā)生率較低，具有顯著的臨床優(yōu)勢。

[關(guān)鍵詞]腹腔鏡技術(shù)；經(jīng)皮腎鏡手術(shù)；輸尿管狹窄；輸尿管上段結(jié)石

[中圖分類號] R693+.4 [文獻(xiàn)標(biāo)識碼] A [文章編號] 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

輸尿管結(jié)石（尤其是輸尿管上段結(jié)石）是常見的泌尿外科疾病之一[1-2]。近年來，由于生活節(jié)奏不斷加快、藥物濫用情況愈發(fā)增加等因素的影響，輸尿管結(jié)石的發(fā)病率顯著上升[3-5]。在所有輸尿管結(jié)石發(fā)病患者中，80%的患者的結(jié)石可自然排出（輸尿管狹窄患者不包括其中），因此，輸尿管上段結(jié)石合并輸尿管狹窄的患者臨床治療較為困難，已成為目前研究的熱點(diǎn)問題之一[6]。作為一門新發(fā)展起來的微創(chuàng)方法，腹腔鏡微創(chuàng)手術(shù)具有創(chuàng)傷小、術(shù)后并發(fā)癥發(fā)生率低、恢復(fù)迅速等優(yōu)點(diǎn)，同時(shí)可大大減少患者的負(fù)擔(dān)和費(fèi)用。近年來，隨著腹腔鏡手術(shù)治療技術(shù)的成熟和推廣，其在泌尿外科疾病中的應(yīng)用也逐漸增加[7]，如腎囊腫切除術(shù)、隱睪的睪丸引降術(shù)、精索靜脈高位結(jié)扎術(shù)等。有研究表明，腹腔鏡手術(shù)亦可作為輸尿管上段結(jié)石合并輸尿管狹窄的治療手段之一，且方法較為安全。本研究選取我院收治的輸尿管上段結(jié)石合并輸尿管狹窄患者作為研究對象，探討腹腔鏡手術(shù)的臨床效果及安全性，現(xiàn)報(bào)道如下。1資料與方法