本文選題：輸尿管狹窄 + 輸尿管鏡�。� 參考：《吉林大學》2017年碩士論文

【摘要】：目的:本文通過輸尿管鏡鈥激光與開放手術(shù)兩種方法治療良性US進行研究,比較兩種手術(shù)方案治療US的治療效果,探討輸尿管鏡鈥激光在臨床中治療良性US的優(yōu)勢。研究方案:回顧性分析吉林大學中日聯(lián)誼醫(yī)院泌尿外科自2014年9月-2016年8月收治的54例良性US的臨床資料。術(shù)前結(jié)合患者病史以及完善相關(guān)輔助檢查,用以明確形成US的原因,部位以及性質(zhì)。確保所有患者均為單側(cè)單發(fā)的小于2cm的良性US,且并排除受外源性壓迫。根據(jù)患者自愿原則進行分組,將輸尿管鏡鈥激光狹窄內(nèi)切開設(shè)為觀察組,共計26人,其中男性19人,女性7人,年齡45.39±9.11歲,狹窄位于輸尿管上段12人,中段8人,下段6人,狹窄長度為1.25±0.44cm,狹窄時間為11.90±2.56個月,腎盂分離程度為2.80±0.49cm;將開放手術(shù)治療設(shè)為對照組,共計28人,其中男性20人,女性8人,年齡46.54±9.99歲,狹窄位于輸尿管上段10人,中段10人,下段8人,狹窄長度為1.36±0.44cm,狹窄時間為13.04±3.44個月,腎盂分離程度為3.01±0.36cm。研究結(jié)果:兩組手術(shù)均按照計劃成功完成且術(shù)中證實US均為良性病變。通過術(shù)后隨訪6個月得出,觀察組手術(shù)治療有效20人,無效4人,有效率為76.92%;對照組手術(shù)治療有效24人,無效4人,有效率為85.71%。經(jīng)統(tǒng)計學分析,通過不兩種不同的手術(shù)方式治療同一種疾病的有效率無統(tǒng)計學差異(即p0.05)。觀察組手術(shù)耗時52.12±11.91min;對照組手術(shù)耗時80.03.12±9.78min,兩者差異有統(tǒng)計學意義(p0.01)。觀察組手術(shù)出血量為12.46±2.70ml;對照組手術(shù)出血量為177.34±10.70ml,兩者差異有統(tǒng)計學意義(p0.01)。觀察組胃腸道恢復(fù)時間2.52±0.26天;對照組胃腸道恢復(fù)時間5.42±0.42天,兩者差異有統(tǒng)計學意義(p0.01)。觀察組術(shù)后住院5.31±0.34天;對照組術(shù)后住院9.11±0.29天。兩者差異有統(tǒng)計學意義(p0.01)。觀察組術(shù)后留置尿管4.42±0.35天;觀察組留置尿管8.30±0.29天,兩者差異有統(tǒng)計學意義(p0.01)。觀察組術(shù)后患者無出現(xiàn)高熱0例,明顯疼痛3例,血尿6例,輸尿管瘺1,腹脹1例,并發(fā)癥發(fā)生率為42.31%;對照組術(shù)后患者無出現(xiàn)高熱2例,明顯疼痛6例,血尿9例,輸尿管瘺2,腹脹3例,并發(fā)癥發(fā)生率為78.57%;經(jīng)X2檢查得出p=0.0060.05,即兩者差異有統(tǒng)計學意義。研究結(jié)論:1.對于小于2cm的非缺血性以及非受外源性壓迫的單側(cè)單發(fā)良性US,采用輸尿管鏡鈥激光與開放手術(shù)治療取得相似的成功率和有效率。2.相比于開放手術(shù),輸尿管鏡鈥激光狹窄內(nèi)切開術(shù)具有更短的手術(shù)時間,術(shù)中出血更少,胃腸道恢復(fù)時間更快,平均住院日更短,術(shù)后并發(fā)癥更少的優(yōu)勢,更容易為患者所接受。
[Abstract]:Objective: to compare the therapeutic effects of ureteroscopic holmium laser and open surgery in the treatment of benign US, and to explore the advantages of ureteroscopic holmium laser in the treatment of benign US. Research scheme: the clinical data of 54 cases of benign US admitted from September 2014 to August 2016 were retrospectively analyzed in the Department of Urology, Sino-Japanese Friendship Hospital of Jilin University. To determine the cause, location and nature of US, combined with patient history and related auxiliary examination. Ensure that all patients have unilateral benign USS less than 2cm and are excluded from external compression. According to the voluntary principle of the patients, the ureteroscopic holmium laser stenosis was divided into observation group (n = 26), including 19 males and 7 females, aged 45.39 鹵9.11 years, 12 patients with ureteral stenosis located in the upper ureter, 8 patients in the middle segment, and 6 patients in the lower ureteral segment. The length of stenosis was 1.25 鹵0.44 cm, the time of stenosis was 11.90 鹵2.56 months, and the degree of renal pelvis separation was 2.80 鹵0.49 cm. The length of stenosis was 1.36 鹵0.44 cm, the time of stenosis was 13.04 鹵3.44 months, and the degree of separation of renal pelvis was 3.01 鹵0.36 cm. Results: both groups were successfully performed according to plan and US was confirmed as benign lesions during operation. The results showed that the effective rate was 76.92 in the observation group, and the effective rate was 85.71 in 24 patients and 4 patients in the control group. By statistical analysis, there was no statistical difference in the effective rate of treating the same disease by two different surgical methods (p0.05). The operative time was 52.12 鹵11.91 min in the observation group and 80.03.12 鹵9.78 min in the control group (P < 0.01). The amount of operative bleeding was 12.46 鹵2.70 ml in the observation group and 177.34 鹵10.70 ml in the control group (P < 0.01). The recovery time of gastrointestinal tract was 2.52 鹵0.26 days in the observation group and 5.42 鹵0.42 days in the control group. The postoperative hospitalization in the observation group was 5.31 鹵0.34 days and in the control group was 9.11 鹵0.29 days. The difference was statistically significant (P 0.01). In the observation group, the indwelling catheter was 4.42 鹵0.35 days after operation, and the observation group was 8.30 鹵0.29 days. The difference between the two groups was statistically significant (p 0.01). In the observation group, there were no hyperpyrexia in 0 cases, obvious pain in 3 cases, hematuria in 6 cases, ureteral fistula in 1 case, abdominal distension in 1 case, complication rate was 42.31%, in the control group, there were no hyperthermia in 2 cases, obvious pain in 6 cases, hematuria in 9 cases. There were 2 ureteral fistula and 3 abdominal distention, the incidence of complications was 78.57.The result of X2 examination showed that p0. 0060.05, that is, the difference was statistically significant. Conclusion: 1. The successful rate and effective rate of ureteroscopic holmium laser and open surgery were similar to those of non-ischemic and unilateral benign USS which were less than 2cm and were not subjected to external compression. Compared with open operation, ureteroscopic holmium laser stenosis endotomy has the advantages of shorter operative time, less intraoperative bleeding, faster gastrointestinal recovery time, shorter average hospital stay, less postoperative complications, and more easily accepted by patients.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R699.4

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