【摘要】：背景復(fù)雜性腎結(jié)石[1]是指鹿角形腎結(jié)石、多發(fā)性腎結(jié)石,伴有腎盞頸狹窄和腎盞擴(kuò)張以及并發(fā)腎盞解剖異常的結(jié)石,如馬蹄形腎結(jié)石、海綿腎結(jié)石等。復(fù)雜性腎結(jié)石治療一直是泌尿外科較為棘手的問題,保持長(zhǎng)期的無石率,降低結(jié)石復(fù)發(fā)率和感染率,積極保護(hù)腎功能是其治療目的。隨著泌尿外科微創(chuàng)技術(shù)的快速發(fā)展,經(jīng)皮腎鏡碎石術(shù)(Percutaneous nephroscope lithotripsy,PCNL)成為復(fù)雜性腎結(jié)石首選的治療方案,尤其是在處理多發(fā)結(jié)石與大型結(jié)石方面具有顯著成效,標(biāo)準(zhǔn)通道經(jīng)皮腎鏡碎石效果高,但標(biāo)準(zhǔn)通道較粗,擺動(dòng)時(shí)容易出血盞頸撕裂,導(dǎo)致出血。在此基礎(chǔ)上出現(xiàn)了微創(chuàng)經(jīng)皮腎鏡碎石術(shù)(Minimally invasive percutaneous nephroscope lithotripsy,MPCNL)。單通道MPCNL氣壓彈道碎石術(shù)往往無法完全發(fā)現(xiàn)或徹底清除結(jié)石。多通道取石術(shù)可獲得較高的結(jié)石清除率,但易損傷腎實(shí)質(zhì),增加并發(fā)癥。故如何減少手術(shù)創(chuàng)傷,提高結(jié)石清除率成為臨床關(guān)注的焦點(diǎn)。目的探討單通道微創(chuàng)經(jīng)皮腎鏡氣壓彈道碎石聯(lián)合輸尿管軟鏡鈥激光碎石治療復(fù)雜性腎結(jié)石的臨床療效和安全性。方法將2015年3月至2016年7月我院收治的96例復(fù)雜性腎結(jié)石患者隨機(jī)分為兩組,每組各48例。對(duì)照組單用單通道MPCNL氣壓彈道碎石治療,觀察組單通道MPCNL氣壓彈道碎石聯(lián)合輸尿管軟鏡鈥激光碎石治療。所有患者術(shù)前均行泌尿系平片、泌尿系彩超檢查、靜脈泌尿系造影或CTU。兩組患者年齡、性別、結(jié)石大小、尿常規(guī)白細(xì)胞陽性率、尿培養(yǎng)陽性率無統(tǒng)計(jì)學(xué)差異。統(tǒng)計(jì)分析兩組患者結(jié)石清除率、手術(shù)時(shí)間、術(shù)后血紅蛋白變化、術(shù)后感染率、術(shù)后尿液轉(zhuǎn)清時(shí)間、并發(fā)癥發(fā)生率以及住院時(shí)間、住院費(fèi)用等資料。結(jié)果觀察組結(jié)石取凈率93.75%(45/48)明顯高于對(duì)照組77.10%(37/48),差異顯著(P0.05);觀察組手術(shù)時(shí)間(58.1±25.2min)較對(duì)照組手術(shù)時(shí)間(46.8±20.5min)延長(zhǎng),具有統(tǒng)計(jì)學(xué)意義(P0.05);觀察組與對(duì)照組相比術(shù)中出血、術(shù)后感染、術(shù)后尿液轉(zhuǎn)清時(shí)間均無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后30min血白細(xì)胞較術(shù)前無明顯統(tǒng)計(jì)學(xué)意義,術(shù)后1h、2h較術(shù)前白細(xì)胞升高(P0.05)。術(shù)前尿常規(guī)白細(xì)胞異常術(shù)后感染發(fā)生率高,具有統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組與對(duì)照組相關(guān)住院費(fèi)用增加(P0.05),但住院時(shí)間無明顯延長(zhǎng)(P0.05)。結(jié)論單通道MPCNL氣壓彈道碎石聯(lián)合腎造瘺輸尿管軟鏡鈥激光碎石治療復(fù)雜性腎結(jié)石療效確切,明顯提高結(jié)石清除效果。
[Abstract]:Background complex renal calculi [1] are staghorn kidney stones, multiple kidney stones, accompanied by renal calyceal neck stricture and renal calyceal dilatation, and complicated with renal calyceal anatomical abnormalities, such as horseshoe-shaped kidney stones, cavernous kidney stones, and so on. The treatment of complex renal calculi has always been a thorny problem in urology. To maintain a long-term stone-free rate, reduce the recurrence rate and infection rate of calculi, and actively protect renal function are the purposes of its treatment. With the rapid development of urological minimally invasive technique, percutaneous nephrolithotripsy (Percutaneous nephroscope lithotripsy,PCNL) has become the first choice for the treatment of complex renal calculi, especially in the treatment of multiple and large stones. The standard passageway has high effect of percutaneous nephrolithotripsy, but the standard channel is thicker, so it is easy to bleed breviscapus when swinging, which leads to bleeding. On this basis, minimally invasive percutaneous nephrolithotripsy (Minimally invasive percutaneous nephroscope lithotripsy,MPCNL) appeared. Single-channel MPCNL pneumatic lithotripsy often fails to completely detect or remove stones. Multi-channel lithotomy can obtain high stone clearance rate, but it is easy to injure renal parenchyma and increase complications. Therefore, how to reduce surgical trauma and improve stone clearance rate has become the focus of clinical attention. Objective to evaluate the clinical efficacy and safety of single-channel minimally invasive percutaneous nephrolithotripsy combined with ureteroscopic holmium: YAG laser lithotripsy in the treatment of complicated renal calculi. Methods from March 2015 to July 2016, 96 patients with complicated renal calculi were randomly divided into two groups with 48 cases in each group. The control group was treated with single-channel MPCNL pneumatic lithotripsy, and the observation group was treated with single-channel MPCNL pneumatic lithotripsy combined with holmium: YAG laser lithotripsy. All patients underwent plain urography, color Doppler urography, intravenous urography or CTU. before operation. There was no significant difference in age, sex, stone size, urine routine leukocyte positive rate and urine culture positive rate between the two groups. The data of stone clearance rate, operation time, postoperative hemoglobin change, postoperative infection rate, postoperative urine clearance time, complication rate, hospitalization time, hospitalization cost and so on in the two groups were statistically analyzed. Results the stone removal rate was 93.75% (45 / 48) in the observation group and 77.10% (37 / 48) in the control group, the difference was significant (P0.05). The operative time in the observation group (58.1 鹵25.2min) was longer than that in the control group (46.8 鹵20.5min) (P0.05). Compared with the control group, there was no significant difference in bleeding, postoperative infection and urine clearance time between the observation group and the control group (P0.05). There was no significant difference between the two groups before and after 30min, but at 1 h and 2 h after operation, the WBC levels were significantly higher than those before operation (P0.05). Preoperative urine routine leucocyte abnormality postoperative infection rate was high, with statistical significance (P0.05). The hospitalization cost of observation group and control group was increased (P0.05), but the length of hospitalization was not significantly prolonged (P0.05). Conclusion single-channel MPCNL pneumatic lithotripsy combined with ureterostomy ureteroscopic holmium: YAG laser lithotripsy is effective in the treatment of complicated renal calculi.
【學(xué)位授予單位】：新鄉(xiāng)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)】：R699.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張慧明;喬慶東;王新麗;;輸尿管軟鏡鈥激光碎石術(shù)治療上尿路結(jié)石的體會(huì)[J];中國內(nèi)鏡雜志;2016年04期

2 張琳;羅海燕;戴圣道;羅林;;彩色多普勒超聲引導(dǎo)下微創(chuàng)經(jīng)皮腎穿刺輸尿管鏡下治療孤立腎腎結(jié)石的臨床應(yīng)用[J];慢性病學(xué)雜志;2016年03期

3 呂玉良;張?jiān)俑?;經(jīng)皮腎鏡氣壓彈道聯(lián)合超聲碎石術(shù)治療感染性腎結(jié)石68例的療效[J];實(shí)用臨床醫(yī)藥雜志;2016年05期

4 張學(xué)齊;郭吉楠;楊江根;袁也晴;黃建生;劉紅艷;黃東龍;張軼庠;;輸尿管軟鏡聯(lián)合鈥激光碎石術(shù)治療上尿路結(jié)石臨床觀察[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2016年04期

5 陳偉;湯春波;齊勇;周永;周酉楓;;二期逆行輸尿管軟鏡聯(lián)合經(jīng)皮腎鏡治療鹿角形腎結(jié)石[J];中國微創(chuàng)外科雜志;2015年12期

6 劉泓鍵;賀煒;奉友剛;余周;劉軍;梁博;;經(jīng)皮腎鏡碎石術(shù)與輸尿管軟鏡碎石術(shù)治療小于2cm腎結(jié)石的Meta分析[J];中華臨床醫(yī)師雜志(電子版);2015年21期

7 梁福律;范先明;郭昭建;林劍鋒;鄭建忠;涂建平;葉振楊;;輸尿管軟鏡碎石術(shù)與經(jīng)皮腎鏡取石術(shù)治療2~2.5cm腎下盞結(jié)石療效對(duì)比[J];現(xiàn)代泌尿外科雜志;2015年07期

8 郭峰;高興華;張龍洋;;單通道微創(chuàng)經(jīng)皮腎鏡聯(lián)合輸尿管軟鏡治療復(fù)雜性腎結(jié)石療效觀察[J];現(xiàn)代泌尿外科雜志;2015年07期

9 李夢(mèng)珂;易成智;楊小明;宋東奎;;輸尿管軟鏡下鈥激光切開內(nèi)引流治療腎盂旁囊腫的療效分析:附視頻[J];中華腔鏡泌尿外科雜志(電子版);2015年02期

10 曾國華;萬肖蓬;陳文忠;劉永達(dá);趙志健;鐘文;吳文起;;超微經(jīng)皮腎鏡取石術(shù)治療31例腎結(jié)石的初步體會(huì)[J];中華泌尿外科雜志;2014年01期

相關(guān)博士學(xué)位論文 前1條

1 鐘文;輸尿管軟鏡碎石術(shù)臨床應(yīng)用及評(píng)估[D];南方醫(yī)科大學(xué);2014年

相關(guān)碩士學(xué)位論文 前1條

1 徐華;輸尿管軟鏡與經(jīng)皮腎鏡治療腎結(jié)石的對(duì)比研究[D];延邊大學(xué);2014年

，

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