輸尿管軟鏡下鈥激光碎石治療腎結(jié)石的臨床療效及安全性
發(fā)布時(shí)間：2018-08-11 15:47
【摘要】：目的泌尿系結(jié)石在泌尿外科中屬于常見病,其發(fā)病率高,影響人群廣泛。研究表明,泌尿系結(jié)石疾病在世界范圍內(nèi)約有5-15%的患者,其中中國國內(nèi)的患者約占1-5%。腎結(jié)石是泌尿結(jié)石中最常見的結(jié)石,其發(fā)病時(shí)的疼痛程度在泌尿結(jié)石中也最高。隨著時(shí)代的進(jìn)步發(fā)展,當(dāng)今快節(jié)奏生活使得眾多上班族人去無暇飲水、長(zhǎng)期久坐,加之以現(xiàn)代生活中的長(zhǎng)期不規(guī)律的生活方式,這使得腎結(jié)石的發(fā)病情況再近年來有不斷增長(zhǎng),且呈年輕化發(fā)病的趨勢(shì)。長(zhǎng)期未得及時(shí)治療的腎結(jié)石會(huì)給人腎臟功能造成一系列的危害,其不僅會(huì)導(dǎo)致結(jié)石在腎盂輸尿管連接處停留從而引起尿路梗阻,而且會(huì)給患者帶來相當(dāng)程度的疼痛感,同時(shí)還會(huì)影響人機(jī)體的其他功能,諸如引起腎功能喪失,嚴(yán)重者還可引發(fā)尿毒癥。腎結(jié)石患者體內(nèi)腎組織會(huì)逐步為脂肪組織所代替,在一些嚴(yán)重病例中,患者的腎組織所剩極少,甚至可完全消失。長(zhǎng)期得不到治療的腎結(jié)石最終可發(fā)展為腎功能衰竭,危及患者的生命。同時(shí)結(jié)石通常含有多種病菌等病原體,其長(zhǎng)期存在易引發(fā)腎臟感染、腎積水等從而導(dǎo)致腎積膿,相反尿路感染又可使結(jié)石并且加重,嚴(yán)重者可引發(fā)敗血病。近年來,隨著醫(yī)療科技的發(fā)展進(jìn)步,輸尿管軟鏡技術(shù)得到了迅速的發(fā)展。輸尿管軟鏡技術(shù)通過泌尿外科理念與工業(yè)設(shè)計(jì)的融合,極大的推動(dòng)了泌尿疾病治療方法的發(fā)展。諸如電子鏡、鈥激光、機(jī)器人輔助輸尿管軟鏡、一次性輸尿管軟鏡、末端可彎輸尿管硬鏡、雙通道輸尿管軟鏡等一系列新設(shè)備的應(yīng)用也極大推動(dòng)了泌尿疾病的治療發(fā)展,讓患者與術(shù)者均獲益匪淺。然而,雖然已有諸多研究關(guān)注輸尿管軟鏡下鈥激光碎石術(shù)的治療效果,但作為一項(xiàng)新技術(shù),更多的臨床評(píng)估資料依然可以為腎結(jié)石的治療以及輸尿管軟鏡下鈥激光碎石術(shù)療效的確切性提供更為堅(jiān)實(shí)的臨床依據(jù)。本研究擬通過回顧性分析2015年3月至2016年2月期間來我院行輸尿管軟鏡鈥激光碎石術(shù)治療腎結(jié)石的患者情況,通過統(tǒng)計(jì)分析患者單次進(jìn)鏡成功率、結(jié)石尋及率、結(jié)石總清除率、手術(shù)時(shí)間、術(shù)中出血量,術(shù)后住院天數(shù)及并發(fā)癥情況,評(píng)價(jià)輸尿管軟鏡鈥激光碎石術(shù)治療腎結(jié)石的臨床療效及安全性。方法回顧性分析自2015年3月至2016年內(nèi)2月期間來浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院行輸尿管軟鏡鈥激光碎石術(shù)治療腎結(jié)石的患者共計(jì)48例。其中男29例,女19例,年齡范圍22～65歲,平均年齡44.9±8.51歲,病程2-40天,平均病程14.35±6.72天。48例患者中,35例因不同程度的腰背或腰腹疼痛就診;6例因肉眼可見血尿就診;其余7例無明顯癥狀的患者經(jīng)體檢發(fā)現(xiàn)腎結(jié)石而就診。患者均經(jīng)B超、KUB、CT等影像學(xué)檢查確認(rèn)為腎結(jié)石。所有患者均為單側(cè)結(jié)石,其中左腎結(jié)石26例,右腎結(jié)石22例。結(jié)石位置為腎上盞結(jié)石15例,腎中盞結(jié)石21例,腎下盞結(jié)石12例。結(jié)石最長(zhǎng)直徑2.1cm-5.5cm,平均直徑2.82±0.96cm。所有患者中5例未行過體外沖擊波碎石,43例患者曾行體外沖擊波碎石1-3次。研究排除患有嚴(yán)重心肺疾病或肝腎功能障礙者;有影響腎功能疾病,如糖尿病、慢性腎炎、高血壓等的患者;泌尿系統(tǒng)感染、腎臟積水嚴(yán)重、尿道狹窄及鹿角狀結(jié)石患者以及其他嚴(yán)重全身性疾病患者。采用輸尿管軟鏡鈥激光碎石術(shù)碎石,術(shù)后3日復(fù)查KUB明確碎石效果及雙J管位置,出院1月復(fù)查KUB確定有誤結(jié)石殘留,結(jié)石清除者拔除雙J管,未清除者可行2次治療。術(shù)中記錄手術(shù)時(shí)間、清石率、術(shù)中出血量等。術(shù)后統(tǒng)計(jì)患者住院天數(shù)術(shù)、留置導(dǎo)尿管時(shí)間及并發(fā)癥情況。術(shù)后2天及1個(gè)月,根據(jù)患者KUB檢查或平掃CT結(jié)果判斷碎石清除情況。統(tǒng)計(jì)分析患者單次進(jìn)鏡成功率、結(jié)石尋及率、結(jié)石總清除率、手術(shù)時(shí)間、術(shù)中出血量,術(shù)后住院天數(shù)及并發(fā)癥情況。結(jié)果1.不同結(jié)石位置的患者術(shù)中情況統(tǒng)計(jì)結(jié)果表明,不同組患者平均手術(shù)時(shí)間上,腎上盞結(jié)石患者及腎中盞結(jié)石患者其平均手術(shù)時(shí)間無顯著差異,P0.05;而腎下盞結(jié)石患者手術(shù)時(shí)間顯著高于腎上盞及中盞患者,差異具有統(tǒng)計(jì)學(xué)意義,P0.05。三組患者在平均術(shù)中出血量上均無顯著差異。2.所有患者中共有40例(83%)患者單次進(jìn)鏡成功,其中腎上盞患者13例(87%)單次進(jìn)鏡成功,腎中盞患者18例(86%)單次進(jìn)鏡成功,腎下盞患者9例(75%)單次進(jìn)鏡成功。腎下盞患者的單次進(jìn)鏡成功率顯著低于腎上盞及中盞患者,差異具有統(tǒng)計(jì)學(xué)意義,P0.05腎上盞與腎中盞患者單次進(jìn)鏡成功率沒有顯著差異,P0.05。所有患者均尋及結(jié)石。3.48例患者中,共有41例(85%)患者一次清除結(jié)石,其中腎上盞中14例(93%)一次清除,1例有殘留;中盞患者中19例(90%)一次清除,2例殘留;下盞患者中8例(67%)一次清除,4例殘留。腎下盞清除率顯著低于上盞及中盞,差異具有統(tǒng)計(jì)學(xué)意義,P0.05。腎上盞及中盞患者結(jié)石清除率沒有顯著差異,P0.05。4.患者住院時(shí)間1～8天,平均住院時(shí)間3.21±0.73天;留置尿管時(shí)間1～2天,平均留置時(shí)間1.72±0.33天,支架管拔除時(shí)間15～30天,平均29.45±3.42天。所有患者術(shù)后情況良好,其中術(shù)后發(fā)熱5例(10%),術(shù)后患側(cè)腰疼6例(13%),術(shù)后血尿3例(6),無嚴(yán)重并發(fā)癥。結(jié)論1.輸尿管軟鏡鈥激光碎石術(shù)在治療腎結(jié)石中具有良好的治療效果,其清石率高、手術(shù)時(shí)間短;2.輸尿管軟鏡鈥激光碎石術(shù)在治療腎結(jié)石中具有良好的安全性,患者恢復(fù)快,術(shù)后無嚴(yán)重并發(fā)癥;3.輸尿管軟鏡鈥激光碎石術(shù)在腎結(jié)石治療中有著良好的臨床效果和安全性,是治療腎結(jié)石的可靠方法。
[Abstract]:Objective Urolithiasis is a common disease in urology, which has a high incidence and affects a wide range of people. Studies have shown that 5-15% of the patients with urolithiasis worldwide, including 1-5% of the patients in China. Kidney stones are the most common urolithiasis, and the degree of pain during the onset of the disease is also the greatest in urolithiasis. Gao. With the progress of the times, the fast-paced life nowadays makes many working people have no time to drink water, long-term sedentary, coupled with the long-term irregular lifestyle in modern life, which makes the incidence of kidney stones in recent years has increased, and the trend of younger onset. Long-term untreated kidney stones will give rise to. Human kidney function causes a series of hazards, which not only causes stones to stay at the ureteropelvic junction and cause urinary tract obstruction, but also gives patients a considerable degree of pain, and also affects other functions of the human body, such as kidney loss, serious cases can also lead to uremia. In some serious cases, the kidney tissue remains very little, or even completely disappears. Long-term untreated kidney stones can eventually develop into renal failure, endangering the lives of patients. At the same time, stones usually contain a variety of pathogens, such as bacteria, which are prone to long-term renal infection, nephrosis. In recent years, with the development of medical science and technology, ureteroscopic technology has been rapidly developed. The ureteroscopic technology has greatly promoted the treatment of urinary diseases through the integration of urological concept and industrial design. The development of methods, such as electronic microscopy, holmium laser, robotic assisted ureteroscope, disposable ureteroscope, end-bendable ureteroscope, dual-channel ureteroscope, and a series of new devices have also greatly promoted the development of treatment of urinary diseases, so that patients and surgeons benefit greatly. However, as a new technique, more clinical evaluation data can still provide a more solid clinical basis for the treatment of renal calculi and the accuracy of the efficacy of flexible ureteroscopic holmium laser lithotripsy. This study is to retrospectively analyze the period from March 2015 to December 2016. The clinical efficacy and safety of holmium laser lithotripsy with flexible ureteroscope in the treatment of renal calculi in our hospital were evaluated by statistical analysis of the success rate of single endoscopic lithotripsy, stone finding rate, total stone clearance rate, operative time, intraoperative bleeding volume, postoperative hospital stay and complications. Methods From March 2015 to February 2016, 48 patients with renal calculi underwent flexible ureteroscopic holmium laser lithotripsy in the First Affiliated Hospital of Medical College of Zhejiang University were analyzed retrospectively. Among them, 29 were males and 19 were females. The age ranged from 22 to 65 years, with an average age of 44.9 (+ 8.51) years and a course of 2 to 40 days, with an average duration of 14.35 (+ 6.72) days. Among them, 35 cases were diagnosed with low back or abdominal pain, 6 cases with visible hematuria, and 7 cases without obvious symptoms were diagnosed with renal calculi by physical examination. Fifteen upper calyx stones, 21 middle calyx stones, and 12 lower calyx stones were located. The longest diameter of the stones was 2.1 cm-5.5 cm, with an average diameter of 2.82 (+ 0.96 cm). Five of the patients did not undergo extracorporeal shock wave lithotripsy and 43 had undergone extracorporeal shock wave lithotripsy. Can disease, such as diabetes, chronic nephritis, hypertension and other patients; urinary tract infection, serious hydronephrosis, urethral stricture and staghorn calculi patients and other serious systemic disease patients. Use ureteroscopic holmium laser lithotripsy ureteroscopic lithotripsy, 3 days after surgery to determine the effect of lithotripsy KUB and double J-tube location, 1 month after discharge to determine KUB. The operation time, stone removal rate and bleeding volume during operation were recorded. The hospitalization days, indwelling catheter time and complications were counted after operation. The lithotripsy was judged according to KUB or plain CT results 2 days and 1 month after operation. The success rate of single endoscopy, stone finding rate, total stone clearance rate, operation time, intraoperative bleeding volume, postoperative hospital stay and complications were analyzed. Results 1. The results showed that the average operation time of patients with upper calyceal calculi and calyceal calculi in different stone positions were different. There was no significant difference (P 0.05), but the operation time of inferior calyx stone patients was significantly longer than that of upper calyx and middle calyx patients, the difference was statistically significant (P 0.05). Eighteen patients (86%) had a successful single endoscopy, and nine patients (75%) had a successful single endoscopy. The success rate of single endoscopy in inferior calyx was significantly lower than that in upper calyx and middle calyx. The difference was statistically significant. There was no significant difference in the success rate of single endoscopy between upper calyx and middle calyx (P 0.05). Of the 48 patients, 41 (85%) had one stone removal, of which 14 (93%) had one stone removal from the upper calyx and 1 residue; 19 (90%) had one stone removal from the middle calyx and 2 residue from the lower calyx; 8 (67%) had one stone removal from the lower calyx and 4 residue from the middle calyx. There was no significant difference in stone clearance rate between the two groups (P There were 6 cases of low back pain (13%) and 3 cases of postoperative hematuria (6) without serious complications. Conclusion 1. Ureteroscopic holmium laser lithotripsy has a good therapeutic effect in the treatment of renal calculi, with a high stone clearance rate and a short operation time; 2. Ureteroscopic holmium laser lithotripsy has a good safety in the treatment of renal calculi, rapid recovery and no serious complications. 3. Ureteroscopic holmium laser lithotripsy has good clinical effect and safety in the treatment of renal calculi. It is a reliable method for the treatment of renal calculi.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R699.2
，
本文編號(hào)：2177442
[Abstract]:Objective Urolithiasis is a common disease in urology, which has a high incidence and affects a wide range of people. Studies have shown that 5-15% of the patients with urolithiasis worldwide, including 1-5% of the patients in China. Kidney stones are the most common urolithiasis, and the degree of pain during the onset of the disease is also the greatest in urolithiasis. Gao. With the progress of the times, the fast-paced life nowadays makes many working people have no time to drink water, long-term sedentary, coupled with the long-term irregular lifestyle in modern life, which makes the incidence of kidney stones in recent years has increased, and the trend of younger onset. Long-term untreated kidney stones will give rise to. Human kidney function causes a series of hazards, which not only causes stones to stay at the ureteropelvic junction and cause urinary tract obstruction, but also gives patients a considerable degree of pain, and also affects other functions of the human body, such as kidney loss, serious cases can also lead to uremia. In some serious cases, the kidney tissue remains very little, or even completely disappears. Long-term untreated kidney stones can eventually develop into renal failure, endangering the lives of patients. At the same time, stones usually contain a variety of pathogens, such as bacteria, which are prone to long-term renal infection, nephrosis. In recent years, with the development of medical science and technology, ureteroscopic technology has been rapidly developed. The ureteroscopic technology has greatly promoted the treatment of urinary diseases through the integration of urological concept and industrial design. The development of methods, such as electronic microscopy, holmium laser, robotic assisted ureteroscope, disposable ureteroscope, end-bendable ureteroscope, dual-channel ureteroscope, and a series of new devices have also greatly promoted the development of treatment of urinary diseases, so that patients and surgeons benefit greatly. However, as a new technique, more clinical evaluation data can still provide a more solid clinical basis for the treatment of renal calculi and the accuracy of the efficacy of flexible ureteroscopic holmium laser lithotripsy. This study is to retrospectively analyze the period from March 2015 to December 2016. The clinical efficacy and safety of holmium laser lithotripsy with flexible ureteroscope in the treatment of renal calculi in our hospital were evaluated by statistical analysis of the success rate of single endoscopic lithotripsy, stone finding rate, total stone clearance rate, operative time, intraoperative bleeding volume, postoperative hospital stay and complications. Methods From March 2015 to February 2016, 48 patients with renal calculi underwent flexible ureteroscopic holmium laser lithotripsy in the First Affiliated Hospital of Medical College of Zhejiang University were analyzed retrospectively. Among them, 29 were males and 19 were females. The age ranged from 22 to 65 years, with an average age of 44.9 (+ 8.51) years and a course of 2 to 40 days, with an average duration of 14.35 (+ 6.72) days. Among them, 35 cases were diagnosed with low back or abdominal pain, 6 cases with visible hematuria, and 7 cases without obvious symptoms were diagnosed with renal calculi by physical examination. Fifteen upper calyx stones, 21 middle calyx stones, and 12 lower calyx stones were located. The longest diameter of the stones was 2.1 cm-5.5 cm, with an average diameter of 2.82 (+ 0.96 cm). Five of the patients did not undergo extracorporeal shock wave lithotripsy and 43 had undergone extracorporeal shock wave lithotripsy. Can disease, such as diabetes, chronic nephritis, hypertension and other patients; urinary tract infection, serious hydronephrosis, urethral stricture and staghorn calculi patients and other serious systemic disease patients. Use ureteroscopic holmium laser lithotripsy ureteroscopic lithotripsy, 3 days after surgery to determine the effect of lithotripsy KUB and double J-tube location, 1 month after discharge to determine KUB. The operation time, stone removal rate and bleeding volume during operation were recorded. The hospitalization days, indwelling catheter time and complications were counted after operation. The lithotripsy was judged according to KUB or plain CT results 2 days and 1 month after operation. The success rate of single endoscopy, stone finding rate, total stone clearance rate, operation time, intraoperative bleeding volume, postoperative hospital stay and complications were analyzed. Results 1. The results showed that the average operation time of patients with upper calyceal calculi and calyceal calculi in different stone positions were different. There was no significant difference (P 0.05), but the operation time of inferior calyx stone patients was significantly longer than that of upper calyx and middle calyx patients, the difference was statistically significant (P 0.05). Eighteen patients (86%) had a successful single endoscopy, and nine patients (75%) had a successful single endoscopy. The success rate of single endoscopy in inferior calyx was significantly lower than that in upper calyx and middle calyx. The difference was statistically significant. There was no significant difference in the success rate of single endoscopy between upper calyx and middle calyx (P 0.05). Of the 48 patients, 41 (85%) had one stone removal, of which 14 (93%) had one stone removal from the upper calyx and 1 residue; 19 (90%) had one stone removal from the middle calyx and 2 residue from the lower calyx; 8 (67%) had one stone removal from the lower calyx and 4 residue from the middle calyx. There was no significant difference in stone clearance rate between the two groups (P There were 6 cases of low back pain (13%) and 3 cases of postoperative hematuria (6) without serious complications. Conclusion 1. Ureteroscopic holmium laser lithotripsy has a good therapeutic effect in the treatment of renal calculi, with a high stone clearance rate and a short operation time; 2. Ureteroscopic holmium laser lithotripsy has a good safety in the treatment of renal calculi, rapid recovery and no serious complications. 3. Ureteroscopic holmium laser lithotripsy has good clinical effect and safety in the treatment of renal calculi. It is a reliable method for the treatment of renal calculi.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R699.2
，
本文編號(hào)：2177442
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