本文選題：經皮腎鏡取石術 + 殘留結石　； 參考：《青島大學》2017年碩士論文

【摘要】：目的:一期PCNL術后殘留結石二期治療方案選擇的問題仍是泌尿外科醫(yī)師需要面對的難題,而殘留結石二期治療方案的選擇沒有一個統(tǒng)一的標準。本文目的在于尋找一期行經皮腎鏡取石術(PCNL)后,影響殘留結石二期手術治療方式選擇的相關因素,為泌尿外科醫(yī)師在選擇治療方案時提供一個參考。方法:回顧性收集上海長海醫(yī)院泌尿外科2015年5月-2016年8月間接受PCNL術后二期殘留結石手術治療的患者的臨床資料,包括年齡、性別、糖尿病、高血壓、殘留結石負荷、手術時間、是否有感染、是否解剖畸形、影像學表現(xiàn)及治療費用、術前肌酐、術后肌酐、術前血紅蛋白、術后血紅蛋白等,計數(shù)資料采用方差分析,計量資料采用卡方檢驗,進行統(tǒng)計學分析。結果:共納入226例患者,其中126例行二期PCNL,93例行F-URL,9例行PCNL聯(lián)合F-URL碎石術。單因素分析結果顯示,術前結石負荷、結石清除率、術中出血量、腎臟解剖畸形、手術時間、治療費用(P0.05)對二期殘留結石手術治療方案的選擇具有統(tǒng)計學意義,而年齡、性別、高血壓、糖尿病、肌酐變化情況、有無尿路感染對手術方式選擇的影響沒有統(tǒng)計學意義。多因素Logistic回顧分析顯示,結石負荷[OR=2.103,95%CI(3.520-6.871)]、結石清除率[OR=2.058,95%CI(1.024-3.265)]、腎臟解剖畸形[OR=1.627,95%CI(1.478-5.521)]是影響殘留結石二期手術方案選擇的獨立因素,此外,在血紅蛋白變化值,手術時間,手術費用等方面在三組之間無明顯統(tǒng)計差異。結論:殘留結石負荷、二期結石的清除率、術中出血量、腎臟解剖畸形、手術時間及治療費用是PCNL術后二期手術治療方案選擇的影響因素。殘留結石負荷、結石清除率、有無解剖畸形是二期手術方式選擇的獨立影響因素。二期PCNL適用于殘留結石負荷較大的患者,具有較高的結石清除率,但是增加了腎臟損傷及出血的風險;F-URL適合于處理殘留結石負荷較小的患者,具有安全性高,術中損傷小,結石清除率較高的特點,是值得推廣的;二期PCNL聯(lián)合F-URL具有安全,高效,而且并發(fā)癥相對較少的優(yōu)點,雖然費用較高,但是對于腎臟解剖復雜的結石殘留患者,可以提高結石清除率。泌尿外科醫(yī)生在選擇殘留結石二期手術治療方式的時候應綜合考慮患者的情況,選擇合適的手術方式。
[Abstract]:Objective: the choice of two stage treatment options for residual stones after PCNL is still a difficult problem in Department of Urology, and there is no unified standard for the choice of the two phase of residual stones. The purpose of this study is to find a stage of percutaneous nephrolithotomy (PCNL) and to affect the choice of the two stages of surgical treatment for residual stones. The relevant factors provide a reference for Department of Urology doctors to choose the treatment plan. Methods: retrospective collection of clinical data of patients undergoing two stages of residual calculi after PCNL operation in Changhai Hospital of Shanghai, May 2015 -2016 year, including age, sex, diabetes, hypertension, residual stone load, operation time, Whether there were infection, dissection of malformation, imaging performance and treatment costs, preoperative creatinine, postoperative creatinine, preoperative hemoglobin, hemoglobin, and postoperative hemoglobin, counting data were analyzed by variance analysis, chi square test was used for statistical analysis. Results: 226 cases were included in 126 cases of two PCNL, 93 cases of F-URL, and 9 cases of PCNL. Combined F-URL lithotripsy. Single factor analysis showed that preoperative lithiasis load, stone clearance, intraoperative bleeding, renal anatomical malformation, operation time, and treatment cost (P0.05) were statistically significant for the selection of surgical treatment for two phase residual stones, while age, sex, hypertension, diabetes, creatinine, and no urinary tract infection The effects of surgical options were not statistically significant. Multiple factor Logistic retrospective analysis showed that stone load [OR=2.103,95%CI (3.520-6.871)], stone clearance rate [OR=2.058,95%CI (1.024-3.265)], renal anatomical malformed [OR=1.627,95%CI (1.478-5.521)] was an independent factor affecting the selection of the two phase of the residual stone operation, in addition to blood red eggs There was no significant statistical difference between the three groups. Conclusion: residual calculi load, two stage stone clearance, intraoperative bleeding, renal anatomical malformation, operation time and treatment cost are the factors influencing the selection of two stages of surgical treatment after PCNL. Residual stone load, stone clearance rate, or not Anatomic malformation is an independent factor in the choice of two stages of operation. The two phase of PCNL is suitable for patients with large residual stone load, with higher stone clearance, but increased risk of renal injury and bleeding; F-URL is suitable for patients with smaller residual stone load, with high safety, small intraoperative damage and stone clearance rate. The high characteristics are worthy of promotion; the two phase PCNL combined with F-URL has the advantages of safety, high efficiency and relatively less complications. Although the cost is high, the stone clearance rate can be improved for the patients with complicated renal anatomy and residual stones. The urologist should take into consideration the comprehensive consideration when choosing the two stage of surgical treatment for the residual stone. In the case of the person, choose the appropriate surgical method.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R699

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