王俊+劉方+易睿

[摘要]目的 探討腹腔鏡手術治療輸尿管上段結(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，隨機分為觀察組和對照組，各18例。觀察組采用腹腔鏡取石手術，對照組采用經(jīng)皮腎鏡手術。記錄兩組的手術時間、住院時間及術后鎮(zhèn)痛藥物使用時間，比較兩組的臨床效果及術后并發(fā)癥發(fā)生率。結(jié)果 觀察組的手術時間、術后鎮(zhèn)痛藥物使用時間顯著短于對照組，差異有統(tǒng)計學意義（P<0.05）。兩組的住院時間比較，差異無統(tǒng)計學意義（P>0.05）。兩組的結(jié)石清除率及不良反應發(fā)生率比較，差異無統(tǒng)計學意義（P>0.05）。結(jié)論 腹腔鏡手術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時間，且不良反應發(fā)生率較低，具有顯著的臨床優(yōu)勢。

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

[中圖分類號] R693+.4 [文獻標識碼] 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)手術具有創(chuàng)傷小、術后并發(fā)癥發(fā)生率低、恢復迅速等優(yōu)點，同時可大大減少患者的負擔和費用。近年來，隨著腹腔鏡手術治療技術的成熟和推廣，其在泌尿外科疾病中的應用也逐漸增加[7]，如腎囊腫切除術、隱睪的睪丸引降術、精索靜脈高位結(jié)扎術等。有研究表明，腹腔鏡手術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，探討腹腔鏡手術的臨床效果及安全性，現(xiàn)報道如下。1資料與方法