【摘要】：目的：比較體外沖擊波碎石術(shù)(extracorporeal shock wave lithotripsy, ESWL)與輸尿管鏡下氣壓彈道碎石術(shù)(ureteroscopic pneumatic lithotripsy, URSL)急診治療輸尿管結(jié)石并急性腎絞痛的療效及并發(fā)癥發(fā)生情況。方法：回顧性分析我院近2年來80例急診ESWL(ESWL組)以及68例急診URSL(URSL組)治療輸尿管結(jié)石并急性腎絞痛患者的臨床及隨訪資料,比較兩組患者的術(shù)后疼痛緩解率、一次性碎石成功率、術(shù)后2周結(jié)石清除率、再次治療率、并發(fā)癥發(fā)生率等指標(biāo)。結(jié)果：經(jīng)統(tǒng)計(jì)分析,URSL組患者術(shù)后疼痛緩解率(95.59%)、一次性碎石成功率(92.65%)、術(shù)后2周結(jié)石清除率(94.12%)均明顯高于ESWL組(分別為76.25%、75.00%、77.50%,P0.05)、再次治療率(10.29%)明顯低于ESWL組(33.75%,P0.05)。兩組輸尿管結(jié)石患者術(shù)后并發(fā)癥發(fā)生率比較無統(tǒng)計(jì)學(xué)差異(分別為27.94%、26.25%,P0.05)。根據(jù)輸尿管結(jié)石位置分布及直徑大小兩種因素分段后分析,與ESWL組患者相比,URSL組結(jié)石位于輸尿管上段及結(jié)石直徑5～10mm的患者一次性碎石成功率、術(shù)后2周結(jié)石清除率以及并發(fā)癥發(fā)生率無統(tǒng)計(jì)學(xué)差異(P0.05);URSL組結(jié)石位于輸尿管中下段以及結(jié)石直徑大于10mm的患者術(shù)后疼痛緩解率、一次性碎石成功率、術(shù)后2周結(jié)石清除率明顯高于ESWL組(P0.05),再次治療率明顯低于ESWL組(P0.05)。結(jié)論：急診ESWL與急診URSL均為輸尿管結(jié)石合并急性腎絞痛應(yīng)用解痙鎮(zhèn)痛藥物無效患者確切有效、安全的治療方法。對(duì)于位于輸尿管上段、直徑5～10mm的結(jié)石,可首選急診ESWL；輸尿管中下段、直徑大于10mm的結(jié)石,首先考慮行急診URSL具備一定的臨床推廣價(jià)值。
[Abstract]:Objective: to compare the efficacy and complications of extracorporeal shock wave lithotripsy (extracorporeal shock wave lithotripsy, ESWL) and pneumatic lithotripsy (ureteroscopic pneumatic lithotripsy, URSL) in the emergency treatment of ureter calculi complicated with acute renal colic. Methods: the clinical and follow-up data of 80 patients with ESWL (ESWL and 68 patients with acute renal colic in our hospital in recent 2 years were analyzed retrospectively. the postoperative pain relief rate, the success rate of disposable lithotripsy, the stone clearance rate 2 weeks after operation, the rate of retreatment and the incidence of complications were compared between the two groups. Results: after statistical analysis, the postoperative pain relief rate (95.59%), the success rate of disposable lithotripsy (92.65%) and the stone clearance rate (94.12%) in URSL group were significantly higher than those in ESWL group (76.25%, 75.00%, 77.50%, P 0.05), and the rate of retreatment (10.29%) was significantly lower than that in ESWL group (33.75%, P 0.05). There was no significant difference in the incidence of postoperative complications between the two groups (27.94%, 26.25%, P 0.05). According to the location distribution and diameter of ureter stones, compared with ESWL group, the success rate of one-off lithotripsy in URSL group was not significantly different from that in 5~10mm patients with upper ureter segment and stone diameter, and there was no significant difference in stone clearance rate and incidence of complications 2 weeks after operation (P 0.05). The pain relief rate of patients with stones located in the middle and lower ureter and patients with stone diameter larger than 10mm in URSL group were significantly higher than those in ESWL group 2 weeks after operation (P 0.05), and the rate of re-treatment was significantly lower than that in ESWL group (P 0.05). Conclusion: both emergency ESWL and emergency URSL are effective and safe methods for the treatment of ureter calculi complicated with acute renal colic with ineffective antispasmodic and analgesic drugs. For stones located in the upper segment of ureter and 5~10mm in diameter, emergency ESWL; is the first choice for middle and lower ureter, and stones larger than 10mm. First of all, emergency URSL has certain clinical value.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699

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