發(fā)布時(shí)間：2018-07-07 18:08

  本文選題：腎結(jié)石 + 輸尿管軟鏡��； 參考：《廣州醫(yī)科大學(xué)》2014年碩士論文

【摘要】：研究目的 對(duì)比分析術(shù)前是否留置雙J管對(duì)行經(jīng)尿道輸尿管軟鏡碎石取石術(shù)患者的療效，安全性的影響。 研究方法 前瞻性對(duì)2013年11月至2014年3月60例行經(jīng)尿道輸尿管軟鏡碎石取石術(shù)的結(jié)石患者進(jìn)行隨機(jī)分組對(duì)照試驗(yàn)。每組30例，一組做好術(shù)前準(zhǔn)備后直接行經(jīng)尿道輸尿管軟鏡碎石取石術(shù)（A組），另一組于入院當(dāng)日局麻下予留置輸尿管雙J管1周后行經(jīng)尿道輸尿管軟鏡碎石取石術(shù)（B組），放置輸尿管軟鏡通道鞘困難者予擴(kuò)張輸尿管，仍不成功者則改行經(jīng)皮腎鏡取石術(shù)或體外碎石術(shù)。對(duì)兩組患者需要擴(kuò)張輸尿管所占比例，手術(shù)時(shí)間，住院時(shí)間，住院費(fèi)用，術(shù)中術(shù)后并發(fā)癥，術(shù)后1-2天及1個(gè)月后結(jié)石清除率等數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析比較。 研究結(jié)果 本課題60例患者均成功I期行經(jīng)尿道輸尿管軟鏡碎石取石術(shù)，兩組患者術(shù)中均未出現(xiàn)輸尿管撕裂、斷裂、穿孔、黏膜脫套及大出血等并發(fā)癥。A組需要擴(kuò)張輸尿管的有6例，3例先予以輸尿管筋膜擴(kuò)張器擴(kuò)張，不能擴(kuò)張至F14，遂用輸尿管球囊擴(kuò)張器擴(kuò)張輸尿管至21F，余下3例均應(yīng)用輸尿管筋膜擴(kuò)張器擴(kuò)張至14F，B組有1例予以輸尿管筋膜擴(kuò)張器擴(kuò)張至14F。兩組一次性放置軟鏡通道鞘成功率分別為24/30(80%)、29/30(96.67%),兩組輸尿管一次性放置軟鏡通道鞘成功率差異比較無(wú)統(tǒng)計(jì)學(xué)意義。A組手術(shù)時(shí)間分別為78.3740.35min，B組分兩次手術(shù)，局麻下逆行插管手術(shù)時(shí)間平均為13.776.88min，Ⅱ期平均手術(shù)時(shí)間為8032.85min；總手術(shù)時(shí)間平均為93.7736.03min。兩組手術(shù)時(shí)間差異比較無(wú)明顯統(tǒng)計(jì)學(xué)意義。全部病例術(shù)后均常規(guī)留置F6或F8雙J管1條。A、B兩組術(shù)后1-2天結(jié)石清除率分別為18/30（60%）、17/30（56.67%），兩組患者術(shù)后無(wú)一例出現(xiàn)體溫＞38.5℃，無(wú)膿毒血癥的出現(xiàn)，全部病例術(shù)后均未出現(xiàn)因大出血需要輸血者。住院治療費(fèi)用分別為19675.982880.03元、21060.566068.02元，差異無(wú)統(tǒng)計(jì)學(xué)意義。住院時(shí)間分別為6.71.74天、11.73.72天，差異比較有統(tǒng)計(jì)學(xué)意義，可明顯縮短患者住院時(shí)間。術(shù)后1個(gè)月結(jié)石清除率兩組分別為29/30(96.67%)、28/30(93.33%)，術(shù)后1個(gè)月結(jié)石清除率差異比較無(wú)統(tǒng)計(jì)學(xué)意義，A組中有一例患者術(shù)后1個(gè)月出現(xiàn)輸尿管石街，再次入院行輸尿管鏡取石術(shù)。 結(jié)論 經(jīng)尿道輸尿管軟鏡碎石取石術(shù)前可不用常規(guī)預(yù)先留置輸尿管雙J管1-2周，手術(shù)安全有效，但需具備輸尿管擴(kuò)張器械（筋膜擴(kuò)張器及球囊擴(kuò)張器）等條件及技術(shù)。
[Abstract]:Objective to compare the effect and safety of double J tube before operation on patients undergoing transurethral soft ureteroscopy lithotripsy. Methods A prospective randomized controlled trial was conducted on 60 patients undergoing transurethral soft ureteroscopic lithotripsy from November 2013 to March 2014. 30 cases in each group, One group received direct transurethral soft ureteroscopy lithotripsy after preoperative preparation (group A), the other group received ureteral double J tube lithotripsy under local anesthesia on the day of admission (group B), and the other group underwent transurethral ureteral lithotripsy (group B) after 1 week of indwelling ureteral double J tube (group B). The ureter was dilated by dilatation of ureteral soft tunnel sheath. Those who still failed were treated with percutaneous nephrolithotomy or extracorporeal lithotripsy. The ratio of ureteral dilation, operation time, hospitalization cost, postoperative complications, stone clearance rate of 1-2 days and 1 month after operation were analyzed and compared between the two groups. Results all 60 patients were successfully treated with transurethral ureteral lithotripsy. No ureteral laceration, rupture or perforation were found in both groups. In group A, 6 cases needed to dilate ureter and 3 cases were treated with ureteral fascia dilator dilatation. The ureteral fascia dilator was used to dilate the ureter to 21F with ureteral balloon dilator. One case in group B was dilated to 14F with ureteral fascia dilator. The successful rate of soft mirror sheath placement in two groups was 24 / 30 (80%) 29 / 30 (96.67%) respectively. There was no significant difference between two groups. The operative time of group A was 78.3740.35 min. The average time of retrograde intubation under local anesthesia was 13.776.88 min, that of stage 鈪，

本文編號(hào)：2105809