【摘要】：目的:探討體外沖擊波碎石術(shù)、輸尿管軟鏡碎石術(shù)和經(jīng)皮腎鏡碎石術(shù)治療腎結(jié)石的療效對比。方法:對我院自2013年1月至2016年12月136例腎結(jié)石患者的臨床治療進行回顧性分析,入院后行泌尿系B超、尿路平片(KUB)、靜脈腎盂造影(IVP)或雙腎CT平掃等檢查確診。其中體外沖擊波碎石(ESWL)組36例,輸尿管軟鏡碎石術(shù)(FURL)組62例,經(jīng)皮腎鏡碎石術(shù)(PCNL)組38例。三組平均年齡分別為(43.61±13.42)歲、(43.68±13.1)歲、(44.37±13.65)歲;結(jié)石平均大小分別為(12.08±2.56)mm、(18.89±2.58)mm、(25.74±4.11)mm。將軟鏡組分為直徑20mm和直徑≥20mm兩組,分別與ESWL及PCNL組比較,比較各組結(jié)石的手術(shù)時間、術(shù)中出血量、一次性結(jié)石清除率、術(shù)后住院時間、術(shù)后并發(fā)癥情況。評價三種治療方式治療不同大小腎結(jié)石的臨床療效。結(jié)果:ESWL組的手術(shù)時間短于軟鏡組(直徑20mm),兩組比較有統(tǒng)計學(xué)差異(t=-7.40,P0.01);ESWL組的術(shù)后住院日短于軟鏡組,兩組比較有統(tǒng)計學(xué)差異(t=-3.14,P=0.003);ESWL組術(shù)后并發(fā)感染3例(共36例),感染率為8.33%,軟鏡組術(shù)后并發(fā)感染4例(共30例),感染率為13.33%,兩組比較無統(tǒng)計學(xué)差異(χ2=0.43,P=0.51);ESWL組1個月時結(jié)石殘留2例(共36例),結(jié)石清除率為94.44%,軟鏡組1個月時結(jié)石殘留2例(共30例),結(jié)石清除率為93.33%,兩組比較無統(tǒng)計學(xué)差異(χ2=0.04,P=0.85)。軟鏡組(直徑≥20mm)的手術(shù)時間長于經(jīng)皮腎鏡組,兩組比較有統(tǒng)計學(xué)差異(t=2.39,P=0.02);軟鏡組的術(shù)中出血少于經(jīng)皮腎鏡組,兩組比較有統(tǒng)計學(xué)差異(t=-6.27,P0.01);軟鏡組的術(shù)后住院日短于經(jīng)皮腎鏡組,兩組比較有統(tǒng)計學(xué)差異(t=-8.46,P0.01);軟鏡組術(shù)后并發(fā)感染5例(共32例),感染率為15.63%,經(jīng)皮腎鏡組術(shù)后并發(fā)感染7例(共38例),感染率為18.42%,兩組比較無統(tǒng)計學(xué)差異(χ2=0.096,P=0.76);軟鏡組1個月時結(jié)石殘留9例(共32例),結(jié)石清除率為71.88%,經(jīng)皮腎鏡組1個月時結(jié)石殘留3例(共38例),結(jié)石清除率為92.11%,經(jīng)皮腎鏡組結(jié)石清除率高于軟鏡組,兩組比較有統(tǒng)計學(xué)差異(χ2=5.01,P=0.03)。結(jié)論:1.體外沖擊波碎石仍是治療直徑20mm腎結(jié)石的主要方法之一,具有安全有效、方便低廉的優(yōu)點。2.FURL治療直徑20mm的腎結(jié)石,一次性清除率高、住院時間短、恢復(fù)快,并發(fā)癥發(fā)生率低,尤其適合治療ESWL定位失敗、碎石無效、ESWL及PCNL術(shù)后殘留,直徑20mm的腎結(jié)石。3.對直徑大于20mm的腎結(jié)石而言,經(jīng)皮腎鏡下碎石術(shù)手術(shù)時間短、清石率高,但有一定的出血風(fēng)險,可考慮首選;對于存在凝血功能異常、解剖結(jié)構(gòu)異常、腎功能不全及穿刺困難的患者,輸尿管軟鏡碎石術(shù)可作為主要手段。
[Abstract]:Objective: to compare the effects of extracorporeal shock wave lithotripsy, soft ureteroscopy and percutaneous nephrolithotripsy in the treatment of renal calculi. Methods: the clinical treatment of 136 patients with renal calculi in our hospital from January 2013 to December 2016 was analyzed retrospectively. After admission, the patients were diagnosed by urography, (KUB), intravenous pyelography (IVP) or double kidney CT plain scan. Among them, 36 cases were treated with extracorporeal shock wave lithotripsy (ESWL), 62 cases with soft ureteral lithotripsy (FURL) and 38 cases with (PCNL) (percutaneous nephrolithotripsy). The mean age of the three groups was (43.61 鹵13.42) years, (43.68 鹵13.1) years, (44.37 鹵13.65) years old, and the mean size of stones was (12.08 鹵2.56) mm, (, 18.89 鹵2.58) mm, (25.74 鹵4.11) mm., respectively. The soft microscope group was divided into two groups: diameter 20mm group and diameter 鈮，

本文編號：2345528