微創(chuàng)經(jīng)皮腎鏡與輸尿管軟鏡下鈥激光碎石治療輸尿管上段結(jié)石的療效比較
發(fā)布時間：2019-05-10 13:02
【摘要】：目的:對比微創(chuàng)經(jīng)皮腎鏡(MPCNL)與輸尿管軟鏡下鈥激光碎石(FURS)治療輸尿管上段結(jié)石的臨床療效。方法:我院2015年6月至2016年1月收治的明確診斷輸尿管上段結(jié)石患者40例,輸尿管上段單發(fā)結(jié)石,結(jié)石直徑在0.7-1.0cm之間行ESWL治療失敗的患者及結(jié)石直徑在1.0-3.0cm之間的患者。根據(jù)手術(shù)方式的不同將患者分為兩組:MPCNL組24例,FURS組16例。對比兩組患者的年齡、結(jié)石大小、積水程度、手術(shù)時間、術(shù)后住院天數(shù)、結(jié)石殘留率、術(shù)后并發(fā)癥、術(shù)后鎮(zhèn)痛劑使用等指標(biāo)。結(jié)果:經(jīng)皮腎鏡組平均手術(shù)時間77.63±13.90min,輸尿管軟鏡組平均手術(shù)時間75.94±28.71min,兩組差異無統(tǒng)計學(xué)意義(P0.05)。經(jīng)皮腎鏡組術(shù)后住院時間8.83±3.02天,輸尿管軟鏡組術(shù)后住院時間4.38±1.09天,兩組間差異對比有統(tǒng)計學(xué)意義(P0.01)。兩組患者手術(shù)均成功,未有因穿刺失敗或輸尿管軟鏡無法置入而導(dǎo)致術(shù)式改變的情況發(fā)生。經(jīng)皮腎鏡組術(shù)后結(jié)石殘留率8.3%(2/24),輸尿管軟鏡組術(shù)后結(jié)石殘留率18.8%(3/16)。經(jīng)皮腎鏡組術(shù)后使用鎮(zhèn)痛劑4例;術(shù)后并發(fā)出血2例,1例經(jīng)保守治療后痊愈,1例行DSA+栓塞治療后痊愈,術(shù)后發(fā)熱1例。輸尿管軟鏡組術(shù)后均未使用鎮(zhèn)痛劑,術(shù)中術(shù)后無明顯并發(fā)癥發(fā)生。結(jié)論:輸尿管軟鏡鈥激光碎石術(shù)治療位于腎盂輸尿管連接部與腎下極水平之間、直徑在0.7-1.0cm之間行ESWL治療失敗的及直徑在1.0-3.0cm的輸尿管上段單發(fā)結(jié)石,較微創(chuàng)經(jīng)皮腎鏡鈥激光碎石術(shù)手術(shù)操作簡單、創(chuàng)傷小、痛苦輕、術(shù)后并發(fā)癥少,但術(shù)前需增加一次住院以留置輸尿管雙J管,增加患者的時間與經(jīng)濟(jì)負(fù)擔(dān),以及留置雙J管帶來的并發(fā)癥的風(fēng)險。臨床上選擇手術(shù)方式時也受到患者腎積水程度的影響,在微創(chuàng)經(jīng)皮腎鏡組患者的腎積水程度較輸尿管軟鏡組重,其差異有統(tǒng)計學(xué)意義。我們認(rèn)為,在臨床上應(yīng)根據(jù)患者的實際情況選擇手術(shù)方式。
[Abstract]:Objective: to compare the clinical efficacy of minimally invasive (MPCNL) and holmium laser lithotripsy (FURS) in the treatment of upper ureter calculi. Methods: from June 2015 to January 2016, 40 patients with upper ureter calculi were diagnosed as single stones in the upper ureter. Patients with stone diameter between 0.7-1.0cm and patients with failed ESWL treatment and patients with stone diameter between 1.0-3.0cm. According to the different surgical methods, the patients were divided into two groups: MPCNL group (n = 24) and FURS group (n = 16). The age, size of stone, degree of hydronephrosis, operation time, days of hospitalization, residual rate of stone, postoperative complications and the use of postoperative analgesic agents were compared between the two groups. Results: the average operation time was 77.63 鹵13.90 min in the percutaneous renoscopy group and 75.94 鹵28.71 min in the ureter soft mirror group. There was no significant difference between the two groups (P 0.05). The postoperative hospital stay was 8.83 鹵3.02 days in the percutaneous renoscopy group and 4.38 鹵1.09 days in the ureter soft mirror group. There was significant difference between the two groups (P 0.01). The operation was successful in both groups, and there was no change of operation caused by the failure of puncture or the inability of ureter soft lens to be inserted. The residual rate was 8.3% (2 / 24) in the percutaneous nephroscopy group and 18.8% (3 / 16) in the soft ureteroscopy group. In the percutaneous renoscopy group, 4 cases were treated with painkillers, 2 cases were complicated with bleeding, 1 case was cured after conservative treatment, 1 case was cured after DSA embolism, and 1 case was febrile after operation. In the soft ureter group, no painkillers were used after operation, and no obvious complications occurred during and after operation. Conclusion: Ureteroscopic holmium laser lithotripsy is located between the junction of the ureter and the inferior pole of the kidney, the diameter of which is between the 0.7-1.0cm and the upper segment of the ureter with the failure of ESWL and the single stone of the upper ureter with the diameter of 1.0-3.0cm. Compared with minimally invasive percutaneous holmium laser lithotripsy, the operation is simple, less trauma, less pain and less postoperative complications, but it is necessary to increase the hospitalization before operation to retain the double J tube of ureter, so as to increase the time and economic burden of the patients. And the risk of complications caused by indwelling double J tube. The degree of hydronephrosis in the minimally invasive percutaneous nephroscopy group was more severe than that in the soft ureteroscopy group, and the difference was significant (P < 0.05). The degree of hydronephrosis was also influenced by the degree of hydronephrosis in the patients with minimally invasive percutaneous nephroscopy. We believe that the surgical method should be selected according to the actual situation of the patients.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R699.4
本文編號：2473670
[Abstract]:Objective: to compare the clinical efficacy of minimally invasive (MPCNL) and holmium laser lithotripsy (FURS) in the treatment of upper ureter calculi. Methods: from June 2015 to January 2016, 40 patients with upper ureter calculi were diagnosed as single stones in the upper ureter. Patients with stone diameter between 0.7-1.0cm and patients with failed ESWL treatment and patients with stone diameter between 1.0-3.0cm. According to the different surgical methods, the patients were divided into two groups: MPCNL group (n = 24) and FURS group (n = 16). The age, size of stone, degree of hydronephrosis, operation time, days of hospitalization, residual rate of stone, postoperative complications and the use of postoperative analgesic agents were compared between the two groups. Results: the average operation time was 77.63 鹵13.90 min in the percutaneous renoscopy group and 75.94 鹵28.71 min in the ureter soft mirror group. There was no significant difference between the two groups (P 0.05). The postoperative hospital stay was 8.83 鹵3.02 days in the percutaneous renoscopy group and 4.38 鹵1.09 days in the ureter soft mirror group. There was significant difference between the two groups (P 0.01). The operation was successful in both groups, and there was no change of operation caused by the failure of puncture or the inability of ureter soft lens to be inserted. The residual rate was 8.3% (2 / 24) in the percutaneous nephroscopy group and 18.8% (3 / 16) in the soft ureteroscopy group. In the percutaneous renoscopy group, 4 cases were treated with painkillers, 2 cases were complicated with bleeding, 1 case was cured after conservative treatment, 1 case was cured after DSA embolism, and 1 case was febrile after operation. In the soft ureter group, no painkillers were used after operation, and no obvious complications occurred during and after operation. Conclusion: Ureteroscopic holmium laser lithotripsy is located between the junction of the ureter and the inferior pole of the kidney, the diameter of which is between the 0.7-1.0cm and the upper segment of the ureter with the failure of ESWL and the single stone of the upper ureter with the diameter of 1.0-3.0cm. Compared with minimally invasive percutaneous holmium laser lithotripsy, the operation is simple, less trauma, less pain and less postoperative complications, but it is necessary to increase the hospitalization before operation to retain the double J tube of ureter, so as to increase the time and economic burden of the patients. And the risk of complications caused by indwelling double J tube. The degree of hydronephrosis in the minimally invasive percutaneous nephroscopy group was more severe than that in the soft ureteroscopy group, and the difference was significant (P < 0.05). The degree of hydronephrosis was also influenced by the degree of hydronephrosis in the patients with minimally invasive percutaneous nephroscopy. We believe that the surgical method should be selected according to the actual situation of the patients.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R699.4
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