【摘要】：目的:隨著生活水平的提高以及飲食習(xí)慣的改變,泌尿系結(jié)石發(fā)病率越來(lái)越高,其中以輸尿管結(jié)石最為常見(jiàn)。輸尿管結(jié)石的治療方法包括保守治療、體外沖擊波碎石、輸尿管鏡下碎石取石術(shù)、經(jīng)皮腎鏡碎石取石術(shù)、腹腔鏡下輸尿管切開(kāi)取石術(shù)以及傳統(tǒng)的開(kāi)放手術(shù)。目前輸尿管鏡下碎石取石術(shù)常見(jiàn)方法包括鈥激光碎石術(shù)和氣壓彈道碎石術(shù)。由于兩組碎石方式的原理不同,故在治療輸尿管結(jié)石的療效及安全性方面可能存在差異。本研究對(duì)比觀察這兩種手術(shù)方式的相關(guān)臨床數(shù)據(jù),運(yùn)用統(tǒng)計(jì)學(xué)方法比較這兩種術(shù)式在治療輸尿管結(jié)石方面的療效及安全性,同時(shí)探討輸尿管鏡下鈥激光碎石術(shù)的臨床經(jīng)驗(yàn),為臨床實(shí)踐提供參考資料。方法:比較我院2014年9月至2016年9月經(jīng)輸尿管鏡下鈥激光碎石術(shù)治療246例和氣壓彈道碎石術(shù)治療215例輸尿管結(jié)石患者的臨床資料。根據(jù)碎石成功率、術(shù)中結(jié)石逃逸率、合并癥(息肉、狹窄)的處理、手術(shù)時(shí)間、住院時(shí)間以及中、術(shù)后并發(fā)癥(術(shù)中輸尿管穿孔、尿外滲、術(shù)中輸尿管黏膜撕脫、術(shù)中輸尿管斷裂、術(shù)后發(fā)熱、術(shù)后血尿)的發(fā)生、結(jié)石清除率等方面的數(shù)據(jù),進(jìn)行統(tǒng)計(jì)學(xué)分析,比較兩種術(shù)式各自的優(yōu)缺點(diǎn)。結(jié)果:對(duì)于輸尿管上段結(jié)石,HL組的碎石成功率、結(jié)石清除率、術(shù)中結(jié)石逃逸率分別是88.37%、83.72%、11.63%,優(yōu)于PL組的67.57%、62.16%、32.43%,差異有統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)于輸尿管中段結(jié)石,HL組的碎石成功率、結(jié)石清除率、術(shù)中結(jié)石逃逸率分別是92.96%、88.73%、7.04%,PL組分別是89.83%、83.05%、10.17%;輸尿管下段結(jié)石,HL組的碎石成功率、結(jié)石清除率、術(shù)中結(jié)石逃逸率分別是97.73%、94.70%、2.27%,PL組分別是97.48%、91.60%、2.52%,對(duì)于中、下段結(jié)石,兩組上述方面差異無(wú)統(tǒng)計(jì)學(xué)意義。HL組的手術(shù)時(shí)間、住院時(shí)間、術(shù)后血尿時(shí)間分別是39.0286±13.0561min、6.2857±1.9034d、1.7290±0.8888d,明顯短于PL組的47.9742±18.1749min、6.7804±2.3384d、2.0327±0.7005d,差異有統(tǒng)計(jì)學(xué)意義(P0.5)。兩組均未發(fā)生嚴(yán)重的術(shù)中、術(shù)后并發(fā)癥,但鈥激光具有對(duì)合并的息肉或狹窄予以燒灼或切開(kāi)后再處理結(jié)石的優(yōu)點(diǎn)。結(jié)論:輸尿管鏡下鈥激光碎石和氣壓彈道碎石術(shù)在治療輸尿管結(jié)石方面均具有安全、有效、創(chuàng)傷小、恢復(fù)快、術(shù)中術(shù)后并發(fā)癥少等特點(diǎn)。對(duì)于輸尿管上段結(jié)石,鈥激光組具有較高的碎石成功率、結(jié)石清除率以及較低的術(shù)中結(jié)石逃逸率;同時(shí)鈥激光組的術(shù)后血尿、手術(shù)時(shí)間、住院時(shí)間等方面優(yōu)于氣壓彈道組,且鈥激光可以術(shù)中一并處理合并的輸尿管息肉、狹窄。輸尿管鏡下鈥激光碎石術(shù)尤其適用于上段輸尿管結(jié)石,特別是合并息肉、狹窄的輸尿管結(jié)石患者,是治療輸尿管結(jié)石理想的手術(shù)方式。
[Abstract]:Objective: with the improvement of living standard and the change of dietary habits, the incidence of urinary calculi is increasing, among which ureteral calculi are the most common. The treatment of ureteral calculi includes conservative treatment, extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy, percutaneous nephrolithotripsy, laparoscopic ureterotomy and traditional open surgery. The common methods of ureteroscopic lithotripsy include holmium laser lithotripsy and pneumatic lithotripsy. There may be differences in the efficacy and safety of the two groups in the treatment of ureteral calculi due to different principles of lithotripsy. In this study, we compared the clinical data of the two surgical procedures, compared the efficacy and safety of the two methods in the treatment of ureteral calculi, and discussed the clinical experience of ureteroscopic holmium laser lithotripsy. To provide reference for clinical practice. Methods: the clinical data of 246 patients treated with holmium laser lithotripsy under ureteroscope and 215 patients with ureteral calculi treated by pneumatic lithotripsy from September 2014 to September 2016 were compared. According to the success rate of lithotripsy, the rate of stone escape during operation, the management of complications (polyp, stenosis), operation time, hospital stay and complications (ureteral perforation, urinary exosmosis, intraoperative ureteral mucosal avulsion, intraoperative ureteral perforation, ureteral mucosal avulsion. The data of ureteral rupture, postoperative fever, postoperative hematuria and stone clearance were analyzed statistically, and the advantages and disadvantages of the two methods were compared. Results: for upper ureteral calculi, the success rate of lithotripsy, the rate of stone clearance and the escape rate of stones in HL group were 88.370.83.72and 11.63respectively, which were better than 67.57 and 32.43in PL group. The difference was statistically significant (P0.05). For the middle ureteral calculi, the lithotripsy success rate, the stone clearance rate and the intraoperative stone escape rate in the HL group were 92.96 and 88.73, respectively. In the PL group, they were 89.83% and 83.05% and 10.17%, respectively. In HL group, the lithotripsy success rate, stone clearance rate and stone escape rate in HL group were 97.73 and 94.70 respectively, and 97.4848 and 91.60 in PL group were 91.60 and 2.52, respectively, and 97.4848 and 91.60 in the middle and lower segment of ureteral calculi, and 91.60 in the middle and lower segment of ureteral calculi, respectively. The operation time, hospitalization time and postoperative hematuria time in HL group were 39.0286 鹵13.0561min and 6.2857 鹵1.9034d, 1.7290 鹵0.8888 days, respectively, which were significantly shorter than those in PL group (47.9742 鹵18.1749min, 6.7804 鹵2.33384d). The difference was statistically significant (2.0327 鹵0.7005 d). There were no serious intraoperative and postoperative complications in both groups, but holmium laser had the advantage of cauterizing or cutting stones after resection or resection of the associated polyps or stenosis. Conclusion: ureteroscopic holmium laser lithotripsy and pneumatic lithotripsy are safe, effective, less invasive, quick recovery and less postoperative complications in the treatment of ureteral calculi. For upper ureteral calculi, holmium laser group had higher lithotripsy success rate, lower stone removal rate and lower escape rate during operation. At the same time, the hematuria, operation time and hospital stay in holmium laser group were better than those in pneumatic ballistic group, and holmium laser could be used to treat ureteral polyps and stricture. Ureteroscopic holmium laser lithotripsy is especially suitable for upper ureteral calculi, especially for ureteral calculi with polyps and narrow ureteral calculi.
【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】：2017
【分類號(hào)】：R699.4

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