發(fā)布時(shí)間：2018-08-12 07:31

【摘要】：目的:探討與對(duì)比開放和后腹腔鏡下離斷性腎盂成形術(shù)治療腎盂輸尿管連接處梗阻的療效。方法:選擇回顧分析2009年4月~2013年3月期間我院收治的腎盂輸尿管連接部梗阻患者120例,分為治療組與對(duì)照組各60例,對(duì)照組給予開放離斷腎盂成形術(shù),治療組給予后腹腔鏡離斷腎盂成形術(shù),觀察兩組的圍手術(shù)指標(biāo)與術(shù)后并發(fā)癥的發(fā)生情況,觀察兩組患者手術(shù)前后的腎積水及腎功能情況,同時(shí)術(shù)后進(jìn)行隨訪調(diào)查6個(gè)月,對(duì)復(fù)發(fā)情況進(jìn)行觀察。全部統(tǒng)計(jì)分析使用SPSS 13.00軟件,設(shè)定P0.05提示差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:所有患者手術(shù)均取得成功,統(tǒng)計(jì)治療組的手術(shù)時(shí)間、手術(shù)中的出血量、術(shù)后腸道排氣時(shí)間、術(shù)后止痛藥使用時(shí)間、術(shù)后住院時(shí)間都明顯少于對(duì)照組,對(duì)比差異經(jīng)t檢驗(yàn)都有統(tǒng)計(jì)學(xué)意義(P0.05)。治療組術(shù)后切口感染、尿漏(漏尿時(shí)間超過兩周)、惡心嘔吐、切口出血、肺部感染等并發(fā)癥發(fā)生情況明顯少于對(duì)照組,組間經(jīng)檢驗(yàn)對(duì)比差異有統(tǒng)計(jì)學(xué)意義(P0.05);所有并發(fā)癥經(jīng)過對(duì)癥處理后好轉(zhuǎn),未影響到術(shù)后隨訪。兩組術(shù)前腎積水狀況對(duì)比差異無(wú)統(tǒng)計(jì)學(xué)意義,術(shù)后腎積水程度都明顯好轉(zhuǎn)(P0.05),同時(shí)術(shù)后治療組的腎積水程度明顯好于對(duì)照組(P0.05)。所有患者術(shù)后隨訪6個(gè)月,經(jīng)過觀察,治療組的梗阻再發(fā)、腎積水加重、腎功能損害腎切除情況都明顯低于對(duì)照組(P0.05)。結(jié)論:后腹腔鏡離斷性腎盂成形術(shù)治療腎盂輸尿管連接部梗阻與傳統(tǒng)開放離斷性腎盂成形術(shù)相比,手術(shù)成功率都比較高,但是后腹腔鏡手術(shù)創(chuàng)傷更小,術(shù)后恢復(fù)更快,能減少并發(fā)癥的發(fā)生,促進(jìn)腎功能的恢復(fù),患者較易接受,隨訪復(fù)發(fā)率也比較少,可逐漸替代傳統(tǒng)開放手術(shù)治療,作為治療腎盂輸尿管連接部梗阻的新的“金標(biāo)準(zhǔn)”。
[Abstract]:Objective: to investigate and compare the efficacy of open and retroperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction. Methods: 120 patients with ureteropelvic junction obstruction treated in our hospital from April 2009 to March 2013 were retrospectively analyzed and divided into treatment group (n = 60) and control group (n = 60). The patients in the treatment group were treated with retroperitoneal laparoscopic pyeloplasty. The perioperative indexes and postoperative complications were observed. The hydronephrosis and renal function were observed before and after operation. The recurrence was observed. All the statistical analysis using SPSS 13.00 software, set P0.05 hint difference was statistically significant. Results: all the patients were successfully operated. The time of operation, the amount of bleeding during operation, the time of intestinal exhaust, the time of postoperative analgesic use, the time of hospitalization after operation in the treatment group were significantly less than those in the control group. The difference was statistically significant by t test (P0.05). In the treatment group, the incidence of incision infection, urine leakage (more than two weeks), nausea and vomiting, incision bleeding, pulmonary infection and other complications were significantly less than those in the control group. The difference between the two groups was statistically significant (P0.05); all the complications were improved after symptomatic treatment and did not affect the postoperative follow-up. There was no significant difference between the two groups in the status of hydronephrosis before operation. The degree of hydronephrosis was significantly improved after operation (P0.05), and the degree of hydronephrosis in the treatment group was significantly better than that in the control group (P0.05). All the patients were followed up for 6 months. After observation, the cases of obstruction, hydronephrosis and nephrectomy in the treatment group were significantly lower than those in the control group (P0.05). Conclusion: compared with traditional open pyeloplasty, the successful rate of retroperitoneal laparoscopic dissecting pyeloplasty for the treatment of ureteropelvic junction obstruction is higher than that of traditional open pyeloplasty, but the wound is less and the postoperative recovery is faster. It can reduce the incidence of complications and promote the recovery of renal function. The patients are easy to accept and the recurrence rate of follow-up is relatively small. It can gradually replace the traditional open surgical treatment as a new "golden standard" for the treatment of ureteropelvic junction obstruction.
【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】：2015
【分類號(hào)】：R699

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