本文選題：輸尿管軟鏡碎石術(shù) + 腎結(jié)石��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]評(píng)估輸尿管軟鏡碎石術(shù)(flexible Ureteroscopic Lithotripsy,f-URL)中使用負(fù)壓吸引輸尿管軟鏡引導(dǎo)鞘(Ureteral Access Sheath,UAS)治療腎結(jié)石的臨床效果,比較該鞘與普通UAS兩者間的應(yīng)用差異。同時(shí)探討f-URL術(shù)后發(fā)生全身炎癥反應(yīng)綜合征(Systemic Inflammatory Response Syndrome,SIRS)的危險(xiǎn)因素,研究負(fù)壓吸引鞘的應(yīng)用在預(yù)防及降低f-URL術(shù)后SIRS發(fā)生的影響。[方法]收集解放軍昆明總醫(yī)院于2015年12月-2017年3月收治的診斷明確且擬行手術(shù)治療的腎結(jié)石患者111例。所有患者均由同一位臨床經(jīng)驗(yàn)豐富的醫(yī)生完成f-URL手術(shù)治療,術(shù)中按軟鏡鞘使用分為觀察組和對(duì)照組,觀察組患者使用新型的帶負(fù)壓測(cè)壓吸引功能的UAS,對(duì)照組則使用普通UAS聯(lián)合軟鏡手術(shù)治療。術(shù)后分別比較兩組患者的手術(shù)時(shí)間、術(shù)后清石率(Stone Free Rate,SFR)、術(shù)后并發(fā)癥及術(shù)后平均住院日等指標(biāo)的差異。并進(jìn)一步將所有患者碎石術(shù)后按是否發(fā)生SIRS進(jìn)行分組,采用單因素和多因素回歸分析f-URL術(shù)后發(fā)生SIRS的危險(xiǎn)因素。[結(jié)果]111例腎結(jié)石患者行軟鏡碎石術(shù)后結(jié)石清除率為88.3%,患者術(shù)后SIRS發(fā)生率為8.1%。術(shù)后SIRS患者中有1例進(jìn)展為尿膿毒血癥,經(jīng)積極抗感染等治療后好轉(zhuǎn)出院。術(shù)中均無腎包膜下血腫、輸尿管粘膜撕脫、輸尿管穿孔等嚴(yán)重并發(fā)癥發(fā)生。觀察組手術(shù)時(shí)間為30.31±8.22min,較對(duì)照組(33.66±7.58 min)手術(shù)時(shí)間縮短,差異有統(tǒng)計(jì)學(xué)意義(P0.05);觀察組SFR 93.7%,較對(duì)照組81.8%更高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);觀察組術(shù)后SIRS發(fā)生率6.3%,較對(duì)照組10.4%降低,差異無統(tǒng)計(jì)學(xué)差異(P0.05);觀察組術(shù)后平均住院日3.01±1.20 d,較對(duì)照組(3.79±1.93 d)住院時(shí)間更短,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)SIRS發(fā)生因變量行單因素分析結(jié)果表明:術(shù)前發(fā)熱、尿硝酸鹽陽性、手術(shù)時(shí)間延長(zhǎng)與軟鏡碎石術(shù)后SIRS發(fā)生相關(guān)。多因素分析提示尿培養(yǎng)陽性是輸尿管軟鏡碎石術(shù)后SIRS發(fā)生的危險(xiǎn)因素。[結(jié)論]輸尿管軟鏡碎石術(shù)治療小于2cm腎結(jié)石安全、有效。術(shù)中使用負(fù)壓吸引輸尿管軟鏡鞘配合軟鏡碎石較普通鞘能更有效的提升術(shù)后清石效果,而新型軟鏡鞘降低術(shù)后SIRS的發(fā)生有待進(jìn)一步研究。尿培養(yǎng)陽性是軟鏡術(shù)后SIRS發(fā)生的獨(dú)立風(fēng)險(xiǎn)因素,對(duì)于術(shù)前合并尿培養(yǎng)陽性、發(fā)熱、尿硝酸鹽陽性等患者,給予積極、有效的抗感染治療,以及術(shù)中控制手術(shù)時(shí)間,盡快完成手術(shù),有助于降低術(shù)后SIRS發(fā)生。
[Abstract]:[objective] to evaluate the clinical effect of ureteroscopic guided ureteral Access guided ureteroscopy (Ureteral Access UASS) in the treatment of renal calculi with flexible Ureteroscopic lithotripsy (UAS), and to compare the difference between the ureteroscopic lithotripsy and the common ureteroscopic lithotripsy (UAS).At the same time, the risk factors of systemic Inflammatory Response syndromes after f-URL were discussed, and the effect of negative pressure suction sheath on the prevention and reduction of SIRS after f-URL was studied.[methods] 111 patients with renal calculi who were admitted to Kunming General Hospital of PLA from December 2015 to March 2017 were collected.All the patients were treated with f-URL by the same experienced doctor. The patients were divided into the observation group and the control group according to the use of soft microscope sheath during the operation.The patients in the observation group were treated with a new type of UAS with suction function of negative pressure and the control group were treated with conventional UAS combined with soft endoscopy.The operative time, stone Free rate, postoperative complications and average hospital stay were compared between the two groups.All patients were further divided according to whether SIRS occurred after lithotripsy. Univariate and multivariate regression analysis was used to analyze the risk factors of SIRS after f-URL.[results] the stone clearance rate was 88.3 in 111 patients with renal calculi and the incidence of SIRS was 8.1 in patients with renal calculi after soft endoscope lithotripsy.One patient with SIRS developed urinary sepsis and was discharged from hospital after active anti-infection therapy.There were no severe complications such as renal subcapsular hematoma, ureteral mucosal avulsion and ureteral perforation.The operative time in the observation group was 30.31 鹵8.22 min, which was shorter than that in the control group (33.66 鹵7.58 min), the difference was statistically significant (P 0.05), the SFR in the observation group was higher than that in the control group (81.8%), the difference was statistically significant, the incidence of SIRS in the observation group was 6.3%, which was lower than that in the control group (10.4%).There was no significant difference between the two groups (P 0.05), and the average hospitalization time of the observation group was 3.01 鹵1.20 days, which was shorter than that of the control group (3.79 鹵1.93 days), and the difference was statistically significant (P 0.05).The results of univariate analysis on the dependent variables of SIRS showed that fever, positive urine nitrate and prolonged operation time were correlated with SIRS after soft endoscope lithotripsy.Multivariate analysis showed that positive urine culture was a risk factor for SIRS after ureteral soft lithotripsy.[conclusion] Ureteroscopic lithotripsy is less safe and effective than 2cm in the treatment of renal calculi.The negative pressure suction ureteral soft sheath combined with soft lithotripsy was more effective than the common sheath in improving the effect of postoperative lithotripsy, but the new soft sheath could reduce the incidence of postoperative SIRS.Positive urine culture is an independent risk factor for the occurrence of SIRS after soft endoscopy. For patients with positive urinary culture, fever and urinary nitrate positive before operation, we should give active and effective anti-infection therapy, and control the operative time during operation.To complete the operation as soon as possible is helpful to reduce the incidence of postoperative SIRS.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R699

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