發(fā)布時(shí)間：2018-06-23 18:36

  本文選題：軟性輸尿管鏡技術(shù) + 經(jīng)皮腎鏡取石術(shù)��； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討采用軟性輸尿管鏡技術(shù)治療經(jīng)皮腎鏡取石術(shù)(PCNL)后殘留結(jié)石的臨床應(yīng)用價(jià)值。方法:選擇2014年12月至2016年10月期間,在廣西醫(yī)科大學(xué)第一附屬醫(yī)院泌尿外科經(jīng)PCNL治療術(shù)中、術(shù)后殘留有結(jié)石的患者52例,采用逆行經(jīng)腔內(nèi)碎石(RIRS)或順行經(jīng)腎造瘺通道輸尿管軟鏡碎石(AFU)進(jìn)行治療。其中男37例,女15例,年齡23-59歲,平均45±6.4歲。PCNL后時(shí)間0-61天。52例患者術(shù)后均有雙J管留置史,其中10例仍留置有腎造瘺通道。本組52例患者中,行PCNL過程中僅建立一個(gè)通道的48例(92.3%),僅4例(7.7%)建立兩個(gè)以上通道。絕大多數(shù)患者腎內(nèi)殘留至少2顆以上的多發(fā)結(jié)石,分布于1至7個(gè)腎盞;而單顆殘留結(jié)石則直徑為0.8-2.4厘米;陰性結(jié)石則直徑大于0.5厘米。統(tǒng)計(jì)手術(shù)時(shí)間,術(shù)后出院時(shí)間,感染發(fā)生率,輸血率,二次RIRS手術(shù)率,凈石率指標(biāo)。結(jié)果:52例患者中,47例(90.4%)直接行RIRS;5例(9.6%)行AFU,其中2例失敗,保留腎造瘺管擇期改行RIRS后成功碎石。行RIRS的49例患者中,5例(10.2%)行2次RIRS,44例(89.8%)僅行一次RIRS。軟性輸尿管鏡操作手術(shù)時(shí)間20-90分鐘(平均42±17分鐘)。48例(92.3%)成功找到腎內(nèi)全部結(jié)石并完全擊碎,2例(4%)未能全部找到腎內(nèi)結(jié)石,2例(4%)找到結(jié)石,但因角度大無法碎石。術(shù)后出現(xiàn)發(fā)熱2例,無繼發(fā)低氧血癥、休克等尿源性膿毒血癥表現(xiàn),經(jīng)抗感染治療后均治愈出院。留置腎造瘺管的10例患者術(shù)后均無發(fā)熱。全部患者術(shù)中、術(shù)后無嚴(yán)重血尿病例,無輸血病例。平均術(shù)后出院時(shí)間1.3±0.3天。術(shù)后2至8周全部患者回院復(fù)診并拔除雙J管。拔除雙J管當(dāng)日發(fā)現(xiàn)腎內(nèi)或輸尿管上段仍有殘留結(jié)石(已經(jīng)擊碎,碎石直徑小于0.3厘米)23例(44.2%)。4例結(jié)石未能完成碎石的患者中,3例改行體外沖擊波碎石術(shù)(ESWL),1例長期隨診觀察處理。拔除雙J管后33例隨診1-6月,其中28例(84.8%)結(jié)石排凈。結(jié)論:軟性輸尿管鏡技術(shù)是處理PCNL術(shù)后殘留結(jié)石的有效手段。
[Abstract]:Objective: to evaluate the clinical value of soft ureteroscopy in the treatment of residual stones after percutaneous nephrolithotomy (PCNL). Methods: from December 2014 to October 2016, 52 patients with residual stones were treated with PCNL in Urology, first affiliated Hospital of Guangxi Medical University. Patients were treated with retrograde endovascular lithotripsy (RIRS) or retrograde ureteral soft lithotripsy (AFU). Among them, 37 males and 15 females aged 23-59 years, mean 45 鹵6.4 years. The mean time after PCNL was 0-61 days. 52 patients had a history of double J tube indwelling after operation, and 10 of them still had renal fistula channels. Of the 52 patients, 48 (92.3%) had only one channel established during PCNL, and only 4 (7.7%) had established two or more channels. Most of the patients had at least two or more residual stones in the kidney, which were distributed in 1 to 7 renal calyces, while the diameter of single residual stones was 0.8-2.4 cm, and the diameter of negative stones was more than 0.5 cm. Operation time, postoperative discharge time, infection rate, blood transfusion rate, secondary RIRS operation rate, net stone rate index. Results among 52 cases, 47 cases (90.4%) were treated directly with RIRSN, 5 cases (9.6%) were treated with AFU, of which 2 cases failed. The successful lithotripsy was performed after selective transposition of RIRS with reserved renal fistula tube. Of 49 patients with RIRS, 5 (10.2%) received RIRSV twice, 44 (89.8%) received RIRS2 only once. The operation time of soft ureteroscopy was 20-90 minutes (mean 42 鹵17 minutes). 48 cases (92.3%) were successfully found all the stones in the kidney and 2 cases (4%) failed to find all the stones in the kidney. There were 2 cases of fever after operation, no secondary hypoxemia, shock and other manifestations of urogenic sepsis. All cases were cured and discharged after anti-infection treatment. No fever was found in 10 patients with renal fistula. There were no serious hematuria cases and no blood transfusion cases in all patients. The average postoperative discharge time was 1.3 鹵0.3 days. From 2 to 8 weeks after operation, all patients returned to hospital and removed double J tubes. In 23 (44.2%) of 23 patients (44.2%) who were found to still have residual stones in the upper part of the kidney or ureter on the day of removal of double J tubes, 3 cases were treated with extracorporeal shock wave lithotripsy (ESWL) and 1 case was followed up for a long time. 33 cases were followed up for 1 to 6 months after removal of double J tubes, of which 28 cases (84.8%) had stones removed. Conclusion: soft ureteroscopy is an effective method to treat residual stones after PCNL.
【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
【分類號(hào)】：R699

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 曾國華;李佳勝;趙志健;劉陳黎;劉e，

本文編號(hào)：2058034