本文選題：經(jīng)皮腎鏡取石術(shù) + 殘留結(jié)石��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:一期PCNL術(shù)后殘留結(jié)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(jié)石二期治療方案的選擇沒有一個(gè)統(tǒng)一的標(biāo)準(zhǔn)。本文目的在于尋找一期行經(jīng)皮腎鏡取石術(shù)(PCNL)后,影響殘留結(jié)石二期手術(shù)治療方式選擇的相關(guān)因素,為泌尿外科醫(yī)師在選擇治療方案時(shí)提供一個(gè)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(shù)后二期殘留結(jié)石手術(shù)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(jié)石負(fù)荷、手術(shù)時(shí)間、是否有感染、是否解剖畸形、影像學(xué)表現(xiàn)及治療費(fèi)用、術(shù)前肌酐、術(shù)后肌酐、術(shù)前血紅蛋白、術(shù)后血紅蛋白等,計(jì)數(shù)資料采用方差分析,計(jì)量資料采用卡方檢驗(yàn),進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)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(shù)。單因素分析結(jié)果顯示,術(shù)前結(jié)石負(fù)荷、結(jié)石清除率、術(shù)中出血量、腎臟解剖畸形、手術(shù)時(shí)間、治療費(fèi)用(P0.05)對二期殘留結(jié)石手術(shù)治療方案的選擇具有統(tǒng)計(jì)學(xué)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(shù)方式選擇的影響沒有統(tǒng)計(jì)學(xué)意義。多因素Logistic回顧分析顯示,結(jié)石負(fù)荷[OR=2.103,95%CI(3.520-6.871)]、結(jié)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(jié)石二期手術(shù)方案選擇的獨(dú)立因素,此外,在血紅蛋白變化值,手術(shù)時(shí)間,手術(shù)費(fèi)用等方面在三組之間無明顯統(tǒng)計(jì)差異。結(jié)論:殘留結(jié)石負(fù)荷、二期結(jié)石的清除率、術(shù)中出血量、腎臟解剖畸形、手術(shù)時(shí)間及治療費(fèi)用是PCNL術(shù)后二期手術(shù)治療方案選擇的影響因素。殘留結(jié)石負(fù)荷、結(jié)石清除率、有無解剖畸形是二期手術(shù)方式選擇的獨(dú)立影響因素。二期PCNL適用于殘留結(jié)石負(fù)荷較大的患者,具有較高的結(jié)石清除率,但是增加了腎臟損傷及出血的風(fēng)險(xiǎn);F-URL適合于處理殘留結(jié)石負(fù)荷較小的患者,具有安全性高,術(shù)中損傷小,結(jié)石清除率較高的特點(diǎn),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(diǎn),雖然費(fèi)用較高,但是對于腎臟解剖復(fù)雜的結(jié)石殘留患者,可以提高結(jié)石清除率。泌尿外科醫(yī)生在選擇殘留結(jié)石二期手術(shù)治療方式的時(shí)候應(yīng)綜合考慮患者的情況,選擇合適的手術(shù)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(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：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10條

1 黃占洪;李文科;劉躍光;趙坤;;經(jīng)皮腎鏡取石術(shù)與輸尿管軟鏡碎石術(shù)治療腎下盞結(jié)石的療效對比[J];腹腔鏡外科雜志;2017年03期

2 黃向江;郭吉楠;張軼庠;江洪濤;楊江根;;Ⅱ期經(jīng)皮腎鏡碎石聯(lián)合逆行輸尿管軟鏡治療PCNL術(shù)后殘余結(jié)石[J];微創(chuàng)泌尿外科雜志;2016年06期

3 陳柏君;;微創(chuàng)經(jīng)皮腎鏡碎石術(shù)術(shù)后結(jié)石殘留的相關(guān)因素分析[J];中華全科醫(yī)學(xué);2016年05期

4 楊淼;;鑄型結(jié)石患者經(jīng)皮腎鏡碎石術(shù)治療后結(jié)石殘留的臨床處理[J];中國民康醫(yī)學(xué);2016年08期

5 沈鋒;陸佳偉;繆惠東;袁曉林;;微通道經(jīng)皮腎鏡取石術(shù)后結(jié)石殘留原因分析及對策[J];當(dāng)代醫(yī)學(xué);2016年09期

6 陳偉;湯春波;齊勇;周永;周酉楓;;二期逆行輸尿管軟鏡聯(lián)合經(jīng)皮腎鏡治療鹿角形腎結(jié)石[J];中國微創(chuàng)外科雜志;2015年12期

7 藍(lán)志相;王偉;蔡斌;郝南;;枸櫞酸氫鉀鈉防治經(jīng)皮腎鏡取石術(shù)后結(jié)石殘留及復(fù)發(fā)的研究[J];中國臨床新醫(yī)學(xué);2015年11期

8 胡衛(wèi)國;唐宇哲;肖博;張鑫;陳松;劉宇保;李建興;;多鏡聯(lián)合一期治療復(fù)雜性上尿路結(jié)石的療效觀察[J];臨床泌尿外科雜志;2015年11期

9 劉定益;俞家順;王健;唐崎;周燕峰;張金根;陳榮國;;輸尿管硬鏡聯(lián)合軟鏡鈥激光治療腎盂2~3cm結(jié)石42例報(bào)告[J];中國微創(chuàng)外科雜志;2015年09期

10 廖松柏;武英杰;于永剛;李學(xué)德;劉為池;于管天;付海生;朱良振;;預(yù)置雙穿刺徑路技術(shù)在經(jīng)皮腎鏡取石術(shù)治療鹿角形腎結(jié)石中的應(yīng)用[J];臨床泌尿外科雜志;2015年09期

，

本文編號(hào)：2072557