摘要
目的评价后腹腔镜输尿管切开取石术(RLU)治疗嵌顿性输尿管下段结石伴感染的效果。方法64例嵌顿性输尿管下段结石伴感染患者,依据随机双盲法分为对照组和观察组,每组32例。对照组采取传统开放手术治疗,观察组实施后腹腔镜输尿管切开取石术治疗。比较两组患者的手术相关指标、并发症发生率、结石清除率、肾功能指标及血清炎症因子水平。结果观察组手术时间(68.25±11.23)min、切口长度(3.16±1.02)cm、胃肠功能恢复时间(20.21±5.19)h、拔除引流管时间(3.08±1.16)d、下床活动时间(1.36±0.48)d和住院时间(4.18±1.02)d均短于对照组的(92.71±15.35)min、(11.29±2.48)cm、(37.84±6.96)h、(4.86±1.94)d、(2.88±0.62)d、(6.57±1.81)d,术中出血量(35.73±11.15)ml少于对照组的(60.08±16.27)ml,统计学差异有意义(P<0.05)。观察组并发症发生率6.25%明显低于对照组的25.00%,结石清除率96.88%高于对照组的78.13%,统计学差异有意义(P<0.05)。治疗后,观察组血肌酐(SCr)(102.84±17.32)μmol/L、血尿素氮(BUN)(6.05±1.86)mmol/L、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)(85.15±14.42)ng/ml均低于对照组(118.95±18.95)μmol/L、(7.97±2.55)mmol/L、(97.77±16.33)ng/ml,统计学差异有意义(P<0.05)。治疗后,观察组白细胞介素-1β(IL-1β)(9.21±0.54)pg/ml、降钙素原(PCT)(0.95±0.27)μg/L均低于对照组的(10.33±0.72)pg/ml、(1.24±0.33)μg/L,统计学差异有意义(P<0.05)。结论后腹腔镜输尿管切开取石术在嵌顿性输尿管下段结石伴感染患者治疗中呈现出创伤小、恢复快等优势,可作为优先考虑的治疗手段,值得临床推广。
Objective To evaluate the effect of retroperitoneal laparoscopic ureterolithotomy(RLU)in the treatment of incarcerated lower ureteral calculi accompanied by infection.Methods 64 cases of incarcerated lower ureteral calculi accompanied by infection were divided into a control group and an observation group according to random double-blind method,with 32 cases in each group.The control group was treated with traditional open surgery,and the observation group was treated with retroperitoneal laparoscopic ureterolithotomy.The surgery-related indexes,complication rate,stone free rate,renal function indexes and serum inflammatory factors were compared between the two groups.Results In the observation group,the operation time was(68.25±11.23)min,the incision length was(3.16±1.02)cm,the recovery time of gastrointestinal function was(20.21±5.19)h,the drainage tube removal time was(3.08±1.16)d,the ambulation time was(1.36±0.48)d,and the hospitalization time was(4.18±1.02)d,which were shorter than(92.71±15.35)min,(11.29±2.48)cm,(37.84±6.96)h,(4.86±1.94)d,(2.88±0.62)d,and(6.57±1.81)d in the control group;the observation group had a less intraoperative blood loss of(35.73±11.15)ml than(60.08±16.27)ml in the control group;the statistical difference was significant(P<0.05).The observation group had a significantly lower complication rate of 6.25%than 25.00%in the control group,and a higher stone free rate of 96.88%than 78.13%in the control group.The statistical difference was significant(P<0.05).After treatment,the observation group had serum creatinine(SCr)of(102.84±17.32)μmol/L,blood urea nitrogen(BUN)of(6.05±1.86)mmol/L,and neutrophil gelatinase-associated lipocalin(NGAL)of(85.15±14.42)ng/ml,which were lower than(118.95±18.95)μmol/L,(7.97±2.55)mmol/L,and(97.77±16.33)ng/ml in the control group,and the difference was statistically significant(P<0.05).After treatment,the observation group had levels of interleukin-1β(IL-1β)of(9.21±0.54)pg/ml and procalcitonin(PCT)of(0.95±0.27)μg/L,which were lower than(10.33±0.72)pg/ml and(1.24±0.33)μg/L in the control group,and the difference was statistically significant(P<0.05).Conclusion Retroperitoneal laparoscopic ureterolithotomy has the advantages of less trauma and faster recovery in the treatment of patients with incarcerated lower ureteral calculi accompanied by infection,which can be considered as a priority treatment and is worthy of clinical promotion.
作者
马军
MA Jun(Third Department of Surgery,Wuwei Hospital of Traditional Chinese Medicine,Wuwei 733000,China)
出处
《中国实用医药》
2025年第10期57-60,共4页
China Practical Medicine
关键词
后腹腔镜输尿管切开取石术
嵌顿性输尿管下段结石
感染
治疗优势
Retroperitoneal laparoscopic ureterolithotomy
Incarcerated lower ureteral calculi
Infection
Treatment advantages
