【摘要】：目的:通過對球囊擴(kuò)張、開放手術(shù)與腹腔鏡手術(shù)三種不同術(shù)式治療輸尿管狹窄的效果進(jìn)行比較,了解上述不同手術(shù)方式的優(yōu)缺點(diǎn)及預(yù)后,指導(dǎo)以后的治療。方法:本文選取了吉林大學(xué)第一醫(yī)院泌尿外一科自2011年1月至2015年12月治療的輸尿管狹窄患者,排除了完全閉塞,外部壓迫和惡性腫瘤導(dǎo)致的輸尿管狹窄,確定了其中138例狹窄段長度小于2cm的良性輸尿管狹窄的患者作為我們的研究對象。將138例患者分為A、B、C三組。A組采用經(jīng)尿道逆行球囊擴(kuò)張術(shù)治療,共25例。B組采用腹腔鏡手術(shù)治療,共21例。C組采用開放手術(shù)治療,共92例。比較A、B、C三組患者的手術(shù)時間、術(shù)中出血量、術(shù)后進(jìn)食時間、術(shù)后住院時間、圍手術(shù)期并發(fā)癥及術(shù)后有效率等。術(shù)后有效率為治愈的患者加好轉(zhuǎn)患者所占該組患者數(shù)的百分比。本組研究分為術(shù)后6個月有效率和術(shù)后1年有效率,即拔出雙J管后隨訪6個月和1年所得出的有效率的值,其中6個月有效率稱為短期有效率,1年有效率稱為長期有效率。使用Spss軟件進(jìn)行分析,計數(shù)資料比較采用X2檢驗(yàn),計量資料比較采用LSD-T檢驗(yàn)。P0.05被認(rèn)為具有統(tǒng)計學(xué)意義。結(jié)果:138個患者失訪9個,其中球囊擴(kuò)張組失訪兩個,腹腔鏡組失訪一個,開放手術(shù)組失訪6個。三組患者手術(shù)時間、術(shù)中出血量、術(shù)后進(jìn)食時間、術(shù)后住院天數(shù)通過LSD-T檢驗(yàn)兩兩比較可得,A組在上述四個方面比B組和C組優(yōu)勢明顯(P0.001),B組在術(shù)中出血量、術(shù)后進(jìn)食時間、術(shù)后住院天數(shù)方面比C組更具優(yōu)勢(P0.05),C組在手術(shù)時間方面比B組有優(yōu)勢(P0.001)。三組患者在圍手術(shù)期并發(fā)癥的比較差異無統(tǒng)計學(xué)意義(P=0.451)。術(shù)后6個月有效率之間的比較,三組之間差異不顯著(P=0.836);術(shù)1年有效率之間的比較,三組之間差異顯著(P=0.016),再運(yùn)用Spss軟件進(jìn)行兩兩之間的比較,其中B組和C組的1年有效率相當(dāng)(P=0.754),上述兩組和A組之間1年有效率的比較有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1、對于狹窄段小于2cm的非壓迫性良性輸尿管狹窄,經(jīng)尿道逆行球囊擴(kuò)張術(shù)在手術(shù)時間、術(shù)中出血量、術(shù)后進(jìn)食時間、術(shù)后住院時間等方面較腹腔鏡組及開放手術(shù)組具有明顯的優(yōu)勢,同時具有不亞于上述兩組的短期有效率;而在長期有效率方面,腹腔鏡組和開放手術(shù)組更具有優(yōu)勢;2、腹腔鏡組和開放手術(shù)組在短期和長期有效率方面沒有明顯的差異性,腹腔鏡組在術(shù)中出血量、術(shù)后進(jìn)食時間、術(shù)后住院天數(shù)方面比開放手術(shù)組具有明顯的優(yōu)勢;3、結(jié)合患者狹窄段的長度,腎臟功能,一般身體狀態(tài),再選擇不同的手術(shù)方式。
[Abstract]:Objective: to compare the effects of balloon dilatation, open operation and laparoscopic surgery in the treatment of ureter stricture, and to understand the advantages, disadvantages and prognosis of the above different surgical methods, and to guide the treatment in the future. Methods: the patients with ureter stricture treated from January 2011 to December 2015 were selected from the Department of Urology, the first Hospital of Jilin University, and the ureter stricture caused by complete occlusion, external compression and malignant tumor was excluded. Among them, 138 patients with benign ureter stricture whose length of stricture segment was less than 2cm were identified as the subjects of our study. 138 patients were divided into three groups: group A (n = 25), group B (n = 21) and group C (n = 92). Group A was treated with retrograde balloon dilatation of urethra. Group B was treated with laparoscopic surgery (n = 21). Group C was treated with open surgery (n = 92). The operation time, intraoperative blood loss, postoperative eating time, postoperative hospitalization time, perioperative complications and postoperative effective rate of group A, B and C were compared. The postoperative effective rate was the percentage of cured and improved patients in this group. The study was divided into 6 months effective rate and 1 year effective rate after operation, that is, the effective rate obtained after 6 months and 1 year follow-up after pulling out the double J tube, in which the 6 month effective rate was called short term effective rate and the 1 year effective rate was long term effective rate. Spss software was used for analysis, X2 test was used to compare the counting data, and LSD-T test was used to compare the measurement data. P05 was considered to have statistical significance. Results: nine of 138 patients were lost, including 2 in balloon dilatation group, 1 in laparoscopy group and 6 in open operation group. The operation time, intraoperative blood loss, postoperative eating time and postoperative hospitalization days of the three groups were compared by LSD-T test. Group A was superior to group B and group C in the above four aspects (P0.001group). The postoperative eating time and postoperative hospitalization days were more superior than those in group C (P 0.05), C group was superior to group B in operation time) (P0.001). There was no significant difference in perioperative complications among the three groups (P 鈮，

本文編號：2492339