本文選題：膀胱結(jié)石 + Peel-away鞘�。� 參考：《中國(guó)內(nèi)鏡雜志》2017年10期

【摘要】：目的比較經(jīng)尿道Peel-away鞘輸尿管鏡與經(jīng)尿道輸尿管鏡治療膀胱結(jié)石的效果。方法將該科2013年1月-2015年12月76例膀胱結(jié)石按隨機(jī)原則分為:A組(經(jīng)尿道Peel-away鞘輸尿管鏡膀胱碎石術(shù))45例;B組(經(jīng)尿道輸尿管鏡膀胱碎石術(shù))31例。結(jié)果 76例膀胱結(jié)石均獲一次性碎石取石成功。碎石時(shí)間:A組(17.8±5.9)min,B組(22.7±8.3)min,差異有統(tǒng)計(jì)學(xué)意義(t=2.96,P=0.004);清石時(shí)間:A組(12.6±4.9)min,B組(24.5±5.3)min,差異有統(tǒng)計(jì)學(xué)意義(t=9.90,P=0.000);術(shù)中尿道黏膜損傷:A組(1.0±0.5)分,B組(2.1±0.4)分,差異有統(tǒng)計(jì)學(xué)意義(t=9.47,P=0.000);VAS評(píng)分:A組(1.9±0.6)分,B組(2.6±0.6)分,差異有統(tǒng)計(jì)學(xué)意義(t=4.72,P=0.000);留置導(dǎo)尿管時(shí)間:A組(1.0±0.2)d,B組(1.4±0.9)d,差異有統(tǒng)計(jì)學(xué)意義(t=2.59,P=0.012);住院費(fèi)用:A組(7 437.4±356.7)元,B組(7 296.8±333.8)元,差異無統(tǒng)計(jì)學(xué)意義(t=-1.73,P=0.087)。兩組術(shù)中無膀胱大出血、穿孔和破裂等并發(fā)癥,無中轉(zhuǎn)開放手術(shù)。術(shù)后并發(fā)癥:B組發(fā)生術(shù)后泌尿系感染1例,經(jīng)口服抗生素治療后痊愈;A組發(fā)生術(shù)后尿潴留1例,B組5例,差異有統(tǒng)計(jì)學(xué)意義(χ2=6.43,P=0.011)。隨訪情況:失訪13例,余63例隨訪6~12個(gè)月,兩組各有1例老年男性患者因前列腺增生導(dǎo)致尿潴留;余患者均無再發(fā)結(jié)石,無尿道狹窄。通過統(tǒng)計(jì)分析結(jié)果,發(fā)現(xiàn)A組在碎石時(shí)間、清石時(shí)間、尿道黏膜損傷、術(shù)后疼痛和術(shù)后留置導(dǎo)尿管時(shí)間等方面較B組具有明顯優(yōu)勢(shì)。結(jié)論經(jīng)尿道Peel-away鞘輸尿管鏡與經(jīng)尿道輸尿管鏡治療膀胱結(jié)石療效無明顯差異。經(jīng)尿道Peel-away鞘輸尿管鏡在碎石時(shí)間、清石時(shí)間及避免術(shù)中損傷尿道黏膜方面更優(yōu),兩組手術(shù)費(fèi)用無明顯差異。經(jīng)尿道Peel-away鞘輸尿管鏡是一種值得推廣的內(nèi)鏡膀胱碎石手術(shù)方法。
[Abstract]:Objective to compare the efficacy of transurethral Peel-away ureteroscopy and transurethral ureteroscopy in the treatment of bladder calculi. Methods from January 2013 to December 2015, 76 cases of bladder calculi were randomly divided into two groups: group A (45 cases with transurethral Peel-away ureteroscopic cystolithotripsy) and group B (31 cases with transurethral ureteroscopic cystolithotripsy). Results 76 cases of bladder stones were successfully removed by one-time lithotripsy. The lithotripsy time was 17.8 鹵5.9 min in group B and 22.7 鹵8.3 min in group B, the difference was statistically significant (t = 2.96, P = 0.004), and the time of lithotomy in group A was 12.6 鹵4.9 min, the difference was statistically significant (t 9.90 P 0.000), and the score of urethral mucosal injury in group A was 1.0 鹵0.5, and the score of VAS score in group B was 2.1 鹵0.4), the VAS score of group A was 1.9 鹵0.6) and that of group B was 2.6 鹵0.6, respectively. The time of indwelling urethral catheter in group A was 1. 0 鹵0. 2 鹵0. 9 days, the difference was statistically significant, and the cost of hospitalization in group A was 7 437.4 鹵35. 7) RMB 7 296.8 鹵333. 8) in group B, there was no significant difference between 1. 73 and 0. 0877.The difference was not significant (P < 0. 087), but there was no significant difference in the time of indwelling urethral catheter in group A (1. 0 鹵0. 2 鹵0. 9 鹵0. 012 鹵0. 012), and the cost of hospitalization in group A was 7 437.4 鹵35. 7) in group B, there was no significant difference. There were no complications such as massive bladder hemorrhage, perforation and rupture, and no conversion to open surgery in both groups. Postoperative complications occurred in 1 case of urinary tract infection in group B and 5 cases of postoperative urinary retention in group A after oral antibiotic therapy. The difference was statistically significant (蠂 ~ 2 = 6.43). Follow up: 13 cases were lost and 63 cases were followed up for 6 ~ 12 months. In each group, one elderly male patient caused urinary retention due to prostatic hyperplasia, and none of the remaining patients had recurrent stones and urethral stricture. The results of statistical analysis showed that group A had obvious advantages over group B in lithotripsy time, lithotomy time, urethral mucosal injury, postoperative pain and time of indwelling catheter. Conclusion there is no significant difference between transurethral Peel-away ureteroscopy and transurethral ureteroscopy in the treatment of bladder calculi. The transurethral Peel-away ureteroscopy was better in lithotripsy time, lithotomy time and avoiding urethral mucous membrane injury. There was no significant difference between the two groups in the cost of operation. Transurethral Peel-away sheath ureteroscopy is a method worth popularizing endoscopic bladder lithotripsy.
【作者單位】： 中南大學(xué)湘雅醫(yī)院國(guó)際醫(yī)療部;湖南省株洲市三三一醫(yī)院泌尿外科;
【分類號(hào)】：R699

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