经尿道输尿管软镜碎石取石术前是否预留双J管的对比研究

发布时间：2018-03-05 22:28

本文选题：肾结石　切入点：输尿管软镜　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:对比分析行经尿道输尿管软镜碎石取石术前是预留双J管对手术疗效,安全性的影响。方法:对照研究吉林大学中日联谊医院泌尿外科2015年4月—2016年9月收治的经筛选后的68例行经尿道输尿管软镜碎石取石术的单侧、单发肾结石患者。入组患者均行泌尿系彩超、KUB、全泌尿系CT、IVP及CTU等辅助检查明确诊断为单侧、单发性肾结石(结石直径10mm~20mm);且均符合f-URL的适应证,无相关禁忌症,并排除了既往患侧输尿管手术史、合并泌尿系解剖异常等影响结果分析者和存在肾结核或肾肿瘤者。上述患者随机分为两组:对照组31例为未留置双J管组,试验组37例为预置双J管1周组,其中对照组在完善术前准备的情况下直接行经尿道输尿管软镜碎石取石术;试验组先于门诊局部麻醉下应用膀胱镜留置患侧输尿管双J管1周,然后返院II期行f-URL。两组术中均常规使用14Fr UAS,难以放置者则进行输尿管扩张,若仍无法置入UAS则行II期软镜手术或PCNL。分析比较两组患者在术前年龄、性别、BMI、结石直径、结石位置、术中一次性置入UAS的成功率、手术时间、术中术后并发症发生率、术后3天清石率及术后3个月清石率上的差异。研究结果:两组病例均顺利完成了输尿管软镜碎石取石术,没有严重输尿管损伤(穿孔、断裂、剥脱)、肾损伤、大出血及脓毒性休克等严重并发症的出现。两组病例在年龄、性别、BMI、结石直径、结石位置方面无统计学差异(P0.05)。对照组和试验组的一次性置入UAS的成功率分别为21/31(67.74%),35/37(94.59%);手术时间分别为:(89.39±11.88)min,(78.22±8.99)min,上述差异均有统计学意义(P0.05)。对照组和试验组术后三日清石率分别为61.29%、59.46%;术后3月结石清除率分别为87.10%、91.89%;术中术后并发症发生率分别为6.45%,2.70%;以上差异无统计学意义(P0.05)。结论:输尿管软镜碎石取石术前预留双J管1周能显著提高输尿管软镜通道鞘的一次性置入成功率,缩短手术时间,手术方便有效。
[Abstract]:Objective: to compare and analyze the curative effect of reserving double J tube before transurethral lithotripsy for ureteral lithotripsy. Methods: a comparative study of 68 cases of transurethral soft ureteroscopic lithotripsy was performed in the Department of Urology, Sino-Japanese Friendship Hospital, Jilin University from April 2015 to September 2016. Patients with single renal calculi. All the patients were diagnosed as unilateral renal calculi (stone diameter 10mm or 20mm) by color Doppler ultrasound (KUB). All patients were diagnosed as unilateral renal calculi (stone diameter 10mm or 20mm), all of them were in accordance with the indication of f-URL, and there were no contraindication about it, and all of the patients were diagnosed as unilateral renal calculi (stone diameter of 10 mm or 20 mm), all of them were in accordance with the indication of f-URL. The patients were divided into two groups randomly: the control group (31 cases) without indwelling double J tube, and the control group (31 cases) without indwelling double J tube. 37 cases in the trial group were treated with pre-placed double J tube for 1 week. The control group was treated directly with transurethral soft ureteroscopy lithotripsy under the condition of perfect preoperative preparation. The patients in the trial group were treated with double J tube of the affected side ureter before local anaesthesia for 1 week, and then treated with f-URL in the second phase of the hospital. The patients in both groups were treated with 14Fr UAS-UASduring operation, and ureteral dilatation was performed in those who were difficult to place. If UAS could not be implanted, stage II soft endoscopy or PCNL. were performed. The age, sex, stone diameter, stone location, success rate, operation time and postoperative complications were compared between the two groups. Results: the two groups of patients successfully completed the ureteral soft lithotripsy, no serious ureteral injury (perforation, rupture, exfoliation, renal injury), and no severe ureteral injury (perforation, rupture, exfoliation, renal injury), and no severe ureteral injury (perforation, rupture, exfoliation, renal injury). The occurrence of severe complications such as massive hemorrhage and septic shock. There was no significant difference in the location of stones (P 0.05). The success rate of UAS implantation in the control group and the trial group was 21 / 31 / 67.74 / 35 / 37 / 94.5959, respectively, and the operative time was 89.39 卤11.88 min ~ 78.22 卤8.99 min, respectively. There was a significant difference between the two groups (P < 0.05). The rate of three days' stone removal in the control group and the experimental group was significantly higher than that in the control group and the experimental group. On March, the stone clearance rates were 87.10% and 91.89%, respectively. The incidence of postoperative complications was 6.45% and 2.70%, respectively. There was no significant difference (P 0.05). Conclusion: reserving double J tube before ureteral soft lithotripsy for one week can significantly improve ureter. The successful rate of one-off placement of soft mirror channel sheath, The operation time is shortened and the operation is convenient and effective.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699

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