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目的:比较后腹腔镜(RPL)、经脐单孔腹腔镜(U-LESS)、耻骨上辅助经脐单孔腹腔镜(SA-LESS)肾盂输尿管切开取石术治疗孤立肾上尿路结石的疗效,并探讨其临床应用价值。方法:选择孤立肾上尿路结石患者32例,根据术者经验和患者意愿分为RPL组(12例)、U-LESS组(10例)、SA-LESS组(10例),比较三组手术时间、术中出血量、术后视觉模拟疼痛评分(VAPS)、肠道功能恢复时间、引流管留置时间、并发症发生率、住院时间、患者瘢痕问卷评分(PSAQ)。结果:三组手术均顺利完成,术中术后无严重并发症发生。SA-LESS组和RPL组较U-LESS组手术时间短(P<0.05),SA-LESS组和U-LESS组患者术后PSAQ低于RPL组(P<0.01)。三组术中出血量、术后引流管和导尿管留置时间、肠道功能恢复时间、住院时间、VAPS、并发症发生率的差异无统计学意义(P>0.05)。随访7~40个月,肾积水及肾功能均明显好转,均无结石复发,无输尿管狭窄发生。结论:RPL、U-LESS、SA-LESS三种腹腔镜肾盂输尿管切开取石术治疗孤立肾上尿路结石均安全可行,可成为孤立肾肾盂及输尿管中上段结石的一线治疗方法。SA-LESS美容效果佳,操作较简便,可作为优选。
Objective: To compare the effect of retroperitoneal laparoscopy (RPL), umbilical single hole laparoscopy (U-LESS) and suprapubic assisted ureteropelvic pyelolithotomy (SA-LESS) Efficacy, and explore its clinical value. Methods: Thirty-two cases of isolated upper urinary tract calculi were selected and divided into three groups according to the experience of the surgeon and the wishes of the patients: RPL group (12 cases), U-LESS group (10 cases) and SA-LESS group Operation time, intraoperative blood loss, visual analogue pain score (VAPS), intestinal functional recovery time, drainage tube indwelling time, complication rate, length of stay, and patient’s scar questionnaire score (PSAQ). Results: The three groups of surgery were successfully completed, no serious postoperative complications occurred. Patients in SA-LESS group and RPL group had shorter operative time (P <0.05) than those in U-LESS group, PSAQ in SA-LESS group and U-LESS group were lower than those in RPL group (P <0.01). There were no significant differences among the three groups in the amount of bleeding during operation, postoperative drainage tube and catheter retention time, intestinal function recovery time, hospitalization time, VAPS, complication rate (P> 0.05). Follow-up 7 to 40 months, hydronephrosis and renal function were significantly improved, no recurrence of stones, no ureteral stricture. CONCLUSION: All three laparoscopic ureteropelvic lithotripsy (RPL), U-LESS and SA-LESS are safe and feasible for the treatment of isolated upper urinary tract stones, which can be the first-line treatment for isolated renal pelvis and upper and middle ureteral calculi. SA-LESS beauty effect is good, the operation is more convenient, as a preferred.