目的 比较输尿管软镜钬激光碎石术联合内切开术,与腹腔镜下输尿管切开取石术联合输尿管狭窄段切除＋端端吻合术治疗合并不同长度(＜10 mm vs. 10～20 mm)输尿管狭窄的上段嵌顿性输尿管结石的疗效。方法 回顾性分析武警江苏总队医院2020-01至2024-12收治的合并输尿管狭窄的上段嵌顿性输尿管结石的105例患者资料。根据狭窄长度,分为A组(＜10 mm,n=60)和B组(10～20 mm,n=45)。两组患者再根据手术方式,分为软镜亚组和腹腔镜亚组。对两亚组患者的手术时间、术后住院天数、术中出血量、术后并发症发生率、术后1个月结石清除率、术后6个月输尿管通畅率等主要指标进行统计学分析。结果 A组:软镜亚组及腹腔镜亚组均取得了较高的结石清除率(91.4% vs. 96.0%)和输尿管通畅率(94.3% vs. 100%),无明显差异。软镜亚组在手术时间[(63.1±9.5)min vs.(91.1±6.5)min]、术中出血量[(39.6±7.8) ml vs. (57.0±6.3)ml]、术后住院天数[(3.7±0.6)d vs.(6.8±0.5)d]、术后并发症发生率(8.6% vs. 28.0%)方面均优于腹腔镜亚组,差异有统计学意义。B组:腹腔镜亚组在结石清除率(96.3% vs. 72.2%)和输尿管通畅率(92.6% vs. 66.7%)方面均优于软镜亚组,但手术时间更长[(92.6±5.4)min vs.(62.7±10.4)min],出血更多[(57.9±6.4)ml vs.(34.3±4.4)ml],术后住院时间更久[(6.9±0.6)d vs.(3.7±0.8)d],差异均有统计学意义。结论 对于合并短段(＜10 mm)输尿管狭窄的嵌顿性输尿管结石,输尿管软镜钬激光碎石术联合内切开术可作为首选。而对于合并稍长(10～20 mm)输尿管狭窄的嵌顿性输尿管结石,腹腔镜下输尿管切开取石术联合输尿管狭窄段切除＋端端吻合术在确保结石清除率和输尿管通畅率方面更具优势,是更可靠的治疗方案。
Abstract
Objective To compare the efficacy of flexible ureteroscopic holmium laser lithotripsy combined with endoureterotomy versus laparoscopic ureterolithotomy combined with resection of the stenotic ureteral segment and end-to-end anastomosis in the treatment of proximal impacted ureteral stones with ureteral stenosis of different lengths (<10 mm vs. 10-20 mm). Methods A retrospective analysis was conducted on the data of 105 patients with proximal impacted ureteral stones complicated by ureteral stenosis who were treated at Jiangsu Provincial Corps Hospital of Chinese People's Armed Police Force between January 2020 and December 2024. According to the length of the stenosis, the patients were divided into group A (<10 mm, n=60) and group B (10-20 mm, n=45). Each group was further subdivided into a flexible ureteroscopy subgroup and a laparoscopy subgroup based on the surgical approach. The operation time, postoperative length of hospital stay, intraoperative blood loss, postoperative complication rate, stone-free rate at 1 month, and ureteral patency rate at 6 months were statistically analyzed and compared between the subgroups. Results In group A, both the flexible ureteroscopy and laparoscopy subgroups achieved high stone-free rates(91.4% vs. 96.0%) and ureteral patency rates (94.3% vs. 100%), with no statistically significant differences between the two approaches. The flexible ureteroscopy subgroup demonstrated significant advantages over the laparoscopy subgroup in terms of shorter operation time[(63.1±9.5) min vs. (91.1±6.5) min], less intraoperative blood loss[(39.6±7.8) ml vs. (57.0±6.3) ml], shorter postoperative hospital stay[(3.7±0.6) d vs. (6.8±0.5) d], and a lower postoperative complication rate (8.6% vs. 28.0%). In group B, the laparoscopy subgroup achieved significantly higher stone-free rates (96.3% vs.72.2%) and ureteral patency rates (92.6% vs. 66.7%) than the flexible ureteroscopy subgroup. However, laparoscopy was associated with a longer operation time [(92.6±5.4) min vs. (62.7±10.4) min], greater intraoperative blood loss[(57.9±6.4) ml vs. (34.3±4.4) ml], and a longer postoperative hospital stay[(6.9±0.6) d vs. (3.7±0.8) d]. Conclusions For impacted ureteral stones complicated by short-segment ureteral stenosis (<10 mm), flexible ureteroscopic holmium laser lithotripsy combined with endoureterotomy can be considered the preferred treatment option. In contrast, for impacted ureteral stones associated with longer ureteral stenosis (10-20 mm), laparoscopic ureterolithotomy combined with resection of the stenotic segment and end-to-end anastomosis provides superior stone clearance and ureteral patency, representing a more reliable therapeutic strategy.
关键词
嵌顿性输尿管结石 /
输尿管狭窄 /
输尿管软镜 /
内切开 /
腹腔镜下输尿管切开取石
Key words
impacted ureteral stones /
ureteral stenosis /
flexible ureteroscopy /
endoureterotomy /
laparoscopic ureterolithotomy
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