三種微創(chuàng)手術(shù)治療輸尿管上段復(fù)雜結(jié)石的對(duì)比研究
發(fā)布時(shí)間：2018-07-15 13:33
【摘要】：目的：比較輸尿管鏡碎石術(shù)(ureteroscopy lithotripsy,URL)、經(jīng)皮腎鏡碎石術(shù)(percutaneous nephrolithotomy,PCNL)、后腹腔鏡輸尿管切開取石術(shù)(retroperitoneal laparoscopic ureterolithotomy,RLUL)等三種腔鏡手術(shù)治療輸尿管上段復(fù)雜結(jié)石的療效。以確定三種微創(chuàng)治療方法的優(yōu)劣性及最佳適應(yīng)癥。 方法：查閱近年來關(guān)于腔鏡治療輸尿管上段結(jié)石的重要文獻(xiàn)資料，并搜集近兩年我院泌尿外科使用腔鏡治療輸尿管上段結(jié)石的患者共213例，其中輸尿管鏡碎石術(shù)治療58例、經(jīng)皮腎鏡碎石治療72例、后腹腔鏡輸尿管切開取石治療83例，嚴(yán)格按照入組標(biāo)準(zhǔn)，從三組中每組選取30例患者進(jìn)行統(tǒng)計(jì)學(xué)分析，對(duì)各組手術(shù)時(shí)間、血紅蛋白下降值、住院天數(shù)、住院費(fèi)用、術(shù)后結(jié)石清除率、并發(fā)癥發(fā)生率等指標(biāo)進(jìn)行對(duì)比分析，采用SPSS16.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析。 結(jié)果：（1）URL組、PCNL組、RLUL組手術(shù)時(shí)間分別為34.63±3.67min、64.40±6.17min、61.30±5.72min，統(tǒng)計(jì)學(xué)分析表明URL組手術(shù)時(shí)間明顯短于PCNL組、RLUL組，P值均小于0.01；而PCNL組與RLUR組手術(shù)時(shí)間無明顯差異。（2）URL組、PCNL組、RLUL組術(shù)中血紅蛋白下降值分別為4.17±1.8g/L、20.67±3.43g/L、8.63±2.59g/L，根據(jù)統(tǒng)計(jì)學(xué)分析，RLUL組血紅蛋白下降值要高于URL組，但要明顯低于PCNL組(P＜0.01）。（3）URL組、PCNL組、RLUL組住院天數(shù)分別為4.23±1.50ds、8.23±1.43ds、6.43±1.38ds。統(tǒng)計(jì)學(xué)分析表明RLUL組住院時(shí)間要長于URL組，但是要短于PCNL組(P＜0.01）。（4）URL組、PCNL組、RLUL組住院費(fèi)用分別為：5329±1531、10259±2598、13182±2177元。統(tǒng)計(jì)學(xué)分析表明PCNL組住院費(fèi)用要明顯高于URL組，但是明顯低于RUL組(P＜0.01）。（5）術(shù)后1周復(fù)查泌尿系彩超或者KUB，殘留碎石小于4mm者視為碎石成功。URL組共有4例患者術(shù)后出現(xiàn)大于4mm的殘留結(jié)石，需ESWL輔助治療。URL組、PCNL組、RLUL組術(shù)后1周結(jié)石清石率分別為：86.6%、100%、100%，統(tǒng)計(jì)學(xué)分析表明PCNL組和RLUL組術(shù)后結(jié)石清除率均要明顯高于URL組，P值＜0.05。（6）URL組有兩例出現(xiàn)發(fā)熱，無出血、輸尿管穿孔、繼發(fā)輸尿管狹窄等并發(fā)癥出現(xiàn)；PCNL組分別有2例出現(xiàn)發(fā)熱、2例出現(xiàn)出血；RLUL組僅有1例出現(xiàn)了漏尿、1例出現(xiàn)皮下氣腫。URL組、PCNL組、RLUL組并發(fā)癥發(fā)生率分別為：6.67%、13.3%、6.67%。經(jīng)過統(tǒng)計(jì)學(xué)分析發(fā)現(xiàn)以上三組并發(fā)癥發(fā)生率無明顯差異（P＞0.05）。 結(jié)論：雖然URL具有住院時(shí)間短、手術(shù)創(chuàng)傷小等優(yōu)勢，但是其治療效果欠佳。PCNL治療治療效果好、清石率高，尤其是用于治療輸尿管鏡進(jìn)鏡困難或者體積較大的高位結(jié)石，但是其術(shù)后并發(fā)癥多。在技術(shù)條件成熟的醫(yī)院,RLUL可逐漸代替開放手術(shù),成為治療輸尿管上段復(fù)雜結(jié)石的首選術(shù)式。
[Abstract]:Objective: to compare the efficacy of ureteroscopy lithotripsy (ureteroscopy), percutaneous lithotripsy (PCNL) and retroperitoneal laparoscopic ureterolithotomy (retroperitoneal laparoscopic ureterolithotomy) in the treatment of complex upper ureteral calculi. In order to determine the advantages and disadvantages of three minimally invasive treatment methods and the best indications. Methods: to review the important literature on endoscopic treatment of upper ureteral calculi in recent years, and to collect 213 cases of ureteral calculi treated by endoscopy in our hospital in recent two years, among which 58 cases were treated by ureteroscopic lithotripsy. 72 cases were treated with percutaneous nephrolithotripsy, 83 cases were treated with retroperitoneal laparoscopic ureterolithotomy. According to the standard of entry, 30 patients in each group were selected for statistical analysis. The time of operation, the decrease of hemoglobin and the days of hospitalization were analyzed. The hospital expenses, postoperative stone clearance rate and complication rate were compared. SPSS 16.0 statistical software was used to analyze the data. Results: (1) the operative time of RLUL group was 34.63 鹵3.67 min, 64.40 鹵6.17 min, 61.30 鹵5.72 min, respectively. Statistical analysis showed that the operative time of URL group was significantly shorter than that of PCNL RLUL group (P < 0.01). However, there was no significant difference in the operative time between PCNL group and RLUR group. (2) the decrease of hemoglobin in RLUL group was 4.17 鹵1.8 g / L, 20.67 鹵3.43 g / L respectively. According to statistical analysis, the decrease value of hemoglobin in RLUL group was higher than that in URL group. But the days of hospitalization in RLUL group were significantly lower than those in PCNL group (P < 0. 01). (3). The days of hospitalization in RLUL group were 4. 23 鹵1. 50 dsL, 8. 23 鹵1. 43 dsL, 6. 43 鹵1. 38dsrespectively. Statistical analysis showed that the hospitalization time of RLUL group was longer than that of). (group, but shorter than that of PCNL group (P < 0. 01). (4). Statistical analysis showed that the cost of hospitalization in PCNL group was significantly higher than that in URL group. But it was significantly lower than that in RUL group (P < 0. 01). (5). 4 patients with residual lithotripsy less than 4mm had residual stones larger than 4mm after operation. The stone clearance rate of RLUL group 1 week after operation was 1: 86.6% and 100% respectively. Statistical analysis showed that the stone clearance rate in PCNL group and RLUL group was significantly higher than that in URL group (P < 0.05). (6) two cases in URL group had fever, no bleeding, ureteral perforation. Complications such as secondary ureteral stenosis were found in 2 cases of fever and 2 cases of hemorrhage in RLUL group. In RLUL group, there were only 1 case with leakage of urine and 1 case with subcutaneous emphysema. The complication rate of RLUL group in PCNL group was: 6.6.67% and 13.3% respectively. Statistical analysis showed that there was no significant difference in the incidence of complications among the above three groups (P > 0.05). Conclusion: although URL has the advantages of short hospital stay and less surgical trauma, it has a poor therapeutic effect. PCNL has a high rate of stone clearance, especially for the treatment of ureteroscopic stones with difficult access to endoscopy or large volume of high stones. But there are many postoperative complications. RLUL can gradually replace open surgery and become the first choice for the treatment of upper ureteral complex stones.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699
本文編號(hào)：2124242
[Abstract]:Objective: to compare the efficacy of ureteroscopy lithotripsy (ureteroscopy), percutaneous lithotripsy (PCNL) and retroperitoneal laparoscopic ureterolithotomy (retroperitoneal laparoscopic ureterolithotomy) in the treatment of complex upper ureteral calculi. In order to determine the advantages and disadvantages of three minimally invasive treatment methods and the best indications. Methods: to review the important literature on endoscopic treatment of upper ureteral calculi in recent years, and to collect 213 cases of ureteral calculi treated by endoscopy in our hospital in recent two years, among which 58 cases were treated by ureteroscopic lithotripsy. 72 cases were treated with percutaneous nephrolithotripsy, 83 cases were treated with retroperitoneal laparoscopic ureterolithotomy. According to the standard of entry, 30 patients in each group were selected for statistical analysis. The time of operation, the decrease of hemoglobin and the days of hospitalization were analyzed. The hospital expenses, postoperative stone clearance rate and complication rate were compared. SPSS 16.0 statistical software was used to analyze the data. Results: (1) the operative time of RLUL group was 34.63 鹵3.67 min, 64.40 鹵6.17 min, 61.30 鹵5.72 min, respectively. Statistical analysis showed that the operative time of URL group was significantly shorter than that of PCNL RLUL group (P < 0.01). However, there was no significant difference in the operative time between PCNL group and RLUR group. (2) the decrease of hemoglobin in RLUL group was 4.17 鹵1.8 g / L, 20.67 鹵3.43 g / L respectively. According to statistical analysis, the decrease value of hemoglobin in RLUL group was higher than that in URL group. But the days of hospitalization in RLUL group were significantly lower than those in PCNL group (P < 0. 01). (3). The days of hospitalization in RLUL group were 4. 23 鹵1. 50 dsL, 8. 23 鹵1. 43 dsL, 6. 43 鹵1. 38dsrespectively. Statistical analysis showed that the hospitalization time of RLUL group was longer than that of). (group, but shorter than that of PCNL group (P < 0. 01). (4). Statistical analysis showed that the cost of hospitalization in PCNL group was significantly higher than that in URL group. But it was significantly lower than that in RUL group (P < 0. 01). (5). 4 patients with residual lithotripsy less than 4mm had residual stones larger than 4mm after operation. The stone clearance rate of RLUL group 1 week after operation was 1: 86.6% and 100% respectively. Statistical analysis showed that the stone clearance rate in PCNL group and RLUL group was significantly higher than that in URL group (P < 0.05). (6) two cases in URL group had fever, no bleeding, ureteral perforation. Complications such as secondary ureteral stenosis were found in 2 cases of fever and 2 cases of hemorrhage in RLUL group. In RLUL group, there were only 1 case with leakage of urine and 1 case with subcutaneous emphysema. The complication rate of RLUL group in PCNL group was: 6.6.67% and 13.3% respectively. Statistical analysis showed that there was no significant difference in the incidence of complications among the above three groups (P > 0.05). Conclusion: although URL has the advantages of short hospital stay and less surgical trauma, it has a poor therapeutic effect. PCNL has a high rate of stone clearance, especially for the treatment of ureteroscopic stones with difficult access to endoscopy or large volume of high stones. But there are many postoperative complications. RLUL can gradually replace open surgery and become the first choice for the treatment of upper ureteral complex stones.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699
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