本文選題：輸尿管結(jié)石 + 急性腎損傷　； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討輸尿管逆行插管術(shù)、經(jīng)皮腎穿刺造瘺術(shù)及輸尿管鏡碎石術(shù)對(duì)輸尿管結(jié)石致急性梗阻性腎損傷的急診手術(shù)治療的有效性及安全性。方法:回顧性分析2012年1月至2016年12月期間在廣西醫(yī)科大學(xué)第一附屬醫(yī)院泌尿外科住院治療的101例輸尿管結(jié)石致急性梗阻性腎損傷患者的臨床資料。101例患者入院24小時(shí)內(nèi)均行手術(shù)治療,其中行輸尿管逆行插管術(shù)60例,經(jīng)皮腎造瘺術(shù)20例,輸尿管鏡碎石術(shù)21例。統(tǒng)計(jì)手術(shù)成功率,手術(shù)時(shí)間、術(shù)中出血量、術(shù)后并發(fā)癥、I期住院時(shí)間、術(shù)前、術(shù)后1天,3天、1周、1月血尿素氮、肌酐值等資料,然后對(duì)數(shù)據(jù)進(jìn)行分析,用于評(píng)估及比較。結(jié)果:本組101例患者中輕度腎積水81例,URSL組與輸尿管逆行插管組、PCN組術(shù)前一般情況比較,具有病程短,入院肌酐值低,尿鏡下白細(xì)胞、血常規(guī)白細(xì)胞、中性粒百分比低,差異具有統(tǒng)計(jì)學(xué)意義,輸尿逆行插管組和PCNL組術(shù)前一般情況比較,差異無(wú)統(tǒng)計(jì)學(xué)意義。輸尿管逆行插管術(shù)組、經(jīng)皮腎穿刺造瘺術(shù)組、URSL組解除梗阻成功率分別為75.81%、100%、100%,PCN解除梗阻成功率較輸尿管逆行插管術(shù)高,且差異具有統(tǒng)計(jì)學(xué)意義(P0.05);中-重度腎積水20例,輸尿管逆行插管術(shù)組、PCN組術(shù)前一般情況無(wú)差異,解除梗阻成功率分別為52.38%、100%,PCN成功率較輸尿管逆行插管術(shù)成功率高,且差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。三組手術(shù)時(shí)間差異無(wú)統(tǒng)計(jì)學(xué)意義,但手術(shù)出血量、I期住院時(shí)間,PCN組較輸尿管逆行插管組、URSL組高,且差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。并發(fā)癥方面,輸尿管逆行插管術(shù)組發(fā)生率5.00%(3/60),嚴(yán)重并發(fā)癥1例(1.67%),PCN組發(fā)生率23.07%(6/26),嚴(yán)重并發(fā)癥2例(7.69%)。URSL組發(fā)生率14.29%(3/21),PCN組與輸尿管逆行插管術(shù)組比較,并發(fā)癥發(fā)生率高,且差異具有統(tǒng)計(jì)學(xué)意義(P0.05),而URSL組與PCN組、輸尿管逆行插管組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。101例患者中最終手術(shù)成功解除梗阻87例,14例行血液透析治療,2-5天后行相關(guān)碎石手術(shù)。解除梗阻后腎功能迅速恢復(fù),輸尿管逆行插管術(shù)組、PCN組、URSL組、血液透析+碎石組術(shù)后1月腎功能恢復(fù)情況(BUN、SCr)比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1、輸尿管逆行插管術(shù)、PCN、URSL在處理輸尿管結(jié)石致AKI,均是安全、有效的應(yīng)急治療手段。2、對(duì)于輸尿管結(jié)石致AKI合并嚴(yán)重尿路感染者,首選輸尿管逆行插管術(shù),其次PCN。3、對(duì)于病程短,無(wú)尿路感染及嚴(yán)重合并癥者,URSL治療輸尿管結(jié)石致AKI具有結(jié)石清除率高,免除II期碎石、嚴(yán)重并發(fā)癥少的優(yōu)點(diǎn)。
[Abstract]:Objective: to evaluate the efficacy and safety of retrograde ureteral catheterization percutaneous nephrostomy and ureteroscopic lithotripsy for acute obstructive renal injury caused by ureteral calculi.Methods: the clinical data of 101 patients with acute obstructive renal injury caused by ureteral calculi from January 2012 to December 2016 were analyzed retrospectively. 101 patients were hospitalized in Urology Department, first affiliated Hospital of Guangxi Medical University.All patients received surgical treatment within 24 hours.Among them, 60 cases underwent retrograde ureteral catheterization, 20 cases underwent percutaneous nephrostomy and 21 cases underwent ureteroscopic lithotripsy.The data of success rate, operation time, intraoperative bleeding volume, postoperative complications and hospitalization time of stage I, preoperative, postoperative 1 day, 3 days, 1 week, 1 month blood urea nitrogen, creatinine value, etc., were analyzed and used for evaluation and comparison.Results: among the 101 patients with mild hydronephrosis, 81 cases with mild hydronephrosis were compared with retrograde ureteral catheterization group (PCN group). The patients had shorter course of disease, lower creatinine in admission, lower percentage of white blood cells, blood routine leukocytes and neutrophils.The difference was statistically significant. There was no significant difference between retrograde catheterization group and PCNL group before operation.In the retrograde ureteral catheterization group, the success rate of relieving obstruction in the URSL group was higher than that in the ureteral retrograde catheterization group (75.81%), and the difference was statistically significant (P 0.05), and 20 cases of moderate to severe hydronephrosis.There was no difference before operation in PCN group. The success rate of relieving obstruction was 52.38%. The success rate of PCN was higher than that of retrograde ureteral catheterization, and the difference was statistically significant (P 0.05).There was no significant difference in operative time among the three groups, but the hospitalization time of PCN group was higher than that of ureteral retrograde catheterization group (P 0.01).In terms of complications, the incidence of retrograde ureteral intubation group was 5.00 / 60, severe complication was 1 case, the incidence of severe complication was 23.077 / 26% in PCN group, and the incidence rate of severe complication was 14.29% 321% PCN group compared with retrograde ureteral catheterization group, the incidence rate of serious complication group was higher than that of retrograde ureteral catheterization group.There was no significant difference between URSL group, PCN group and retrograde ureteral catheterization group. Among the 101 cases, 87 cases were successfully relieved of obstruction and 14 cases were treated with hemodialysis for 2 to 5 days.The renal function recovered rapidly after relieving obstruction. There was no significant difference in the recovery of renal function between PCN group and URSL group and hemodialysis lithotripsy group (P 0.05).Conclusion Retrograde ureteral catheterization is a safe and effective emergency treatment for ureteral calculi. Ureteral retrograde catheterization is the first choice for ureteral calculus-induced AKI complicated with severe urinary tract infection, followed by PCN.3, and the course of disease is short.Ureteral calculi in patients without urinary tract infection and severe complications have the advantages of high stone clearance rate, no stage II lithotripsy, and less serious complications.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R699.4

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