本文選題：腎盂結(jié)石 + 輸尿管軟鏡��； 參考：《浙江大學》2014年碩士論文

【摘要】：目的： 比較逆行輸尿管軟鏡下鈥激光碎石術(shù)(FURS)與經(jīng)皮腎鏡鈥激光碎石術(shù)(PCNL)治療2-3cm腎盂結(jié)石的臨床療效、安全性和費用。 方法： 邵逸夫醫(yī)院2011.3-2014.2期間100例單發(fā)的2-3cm腎盂結(jié)石患者納入本研究：隨機分為兩組：輸尿管軟鏡組50例,經(jīng)皮腎鏡組50例。觀察指標：結(jié)石清除率、手術(shù)時間、術(shù)中出血量、輸血百分比、術(shù)后血紅蛋白下降及超敏反應(yīng)蛋白CRP上升量、術(shù)后止痛藥物使用率、術(shù)后并發(fā)癥發(fā)生率、術(shù)后住院時間、總治療費用。 結(jié)果： 輸尿管軟鏡組與經(jīng)皮腎鏡組在術(shù)中出血量上分別為(15.5±1.6)ml與(86.7±13.1)ml；輸血百分比分別為0%(0/50)與8%(4/50)；術(shù)后血紅蛋白下降量分別為(0.9±0.1)g/L與(1.3±0.2)g/L；術(shù)后超敏反應(yīng)蛋白CRP上升量分別為(3.7±1.1)mg/L與(18.7±5.4)mg/L；術(shù)后止痛藥物使用率分別為12%(6/50)：34%(17/50)；術(shù)后住院時間分別為(2.7±0.2)天與(6.0±0.3)天；并發(fā)癥(Clavien分級Ⅱ級)發(fā)生率分別為4%(2/50)和12%(6/50)；總治療費用分別為(23.67±0.61)千元與(27.70±0.81)千元；以上指標差異均在統(tǒng)計學上有意義(P0.05)。結(jié)石清除率(殘石≤4mm)分別為92%(46/50)與94%(47/50)；手術(shù)時間分別為(83.1±4.4)min與(97.3±5.9)min；以上指標差異在統(tǒng)計學上無意義(P0.05)。輸尿管軟鏡組在術(shù)中出血量、輸血百分比、術(shù)后血紅蛋白下降及CRP上升量、術(shù)后住院時間、術(shù)后并發(fā)癥發(fā)生率、總費用上優(yōu)于經(jīng)皮腎鏡組；在結(jié)石清除率、手術(shù)時間上與經(jīng)皮腎鏡無明顯差異。 結(jié)論 相比PCNL,輸尿管軟鏡下鈥激光碎石在治療2-3cm單發(fā)腎盂結(jié)石上具有相似的結(jié)石清除率,且有損傷小、出血少、并發(fā)癥發(fā)生率低、術(shù)后恢復(fù)快、花費少等優(yōu)勢。因此,輸尿管軟鏡有望成為治療2-3cm腎盂結(jié)石的主要手術(shù)方式之一。
[Abstract]:Objective: To compare the efficacy, safety and cost of retrograde ureteroscopic holmium: YAG laser lithotripsy with percutaneous nephrolithotripsy in the treatment of 2-3cm pyelolithiasis. Methods: In this study, 100 patients with 2-3cm pyelolithiasis were randomly divided into two groups: soft ureteroscopy group (n = 50) and percutaneous nephroscopy group (n = 50). Outcome measures: stone clearance rate, operative time, intraoperative bleeding volume, percentage of blood transfusion, decrease of hemoglobin and increase of hypersensitive reactive protein CRP, postoperative analgesic drug utilization rate, postoperative complication rate, postoperative hospitalization time, Total cost of treatment. Results: In the soft ureteroscopy group and the percutaneous nephroscope group, the intraoperative bleeding volumes were 15.5 鹵1.6)ml and 86.7 鹵13.1 ml, respectively; the percentages of blood transfusion were 0: 0 / 50) and 8 / 50 respectively; the postoperative hemoglobin decreased by 0.9 鹵0.1)g/L and 1.3 鹵0.2g / L, respectively; the increase of postoperative hypersensitivity protein CRP was 3.7 鹵1.1)mg/L and 18.7 鹵5.4 mg / L, respectively. The utilization rate of posterior analgesic drugs was 12 / 50: 17 / 50, respectively, and the postoperative hospital stay was 2.7 鹵0.2 days and 6.0 鹵0.3 days, respectively. The incidence of complications of Clavien grade 鈪，

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