电子输尿管软镜在上尿路疾病中的临床应用

发布时间：2018-03-18 10:11

本文选题：电子输尿管软镜　切入点：上尿路疾病　出处：《济南大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的:观察电子输尿管软镜联合钬激光治疗上尿路疾病的疗效。方法:回顾分析了我科自2012年1月至2013年12月应用输尿管软镜诊疗上尿路疾病64例，其中治疗上尿路结石47例（结石体积＜20mm），，输尿管上段结石13例，肾结石34例，观察术中碎石时间、碎石效果、术后并发症情况。为检测结石排净率，可于术后第3天、1个月、3个月分别复查KUB或泌尿系CT。非结石性上尿路疾病17例，统计病种，观察疗效。电子输尿管软镜联合单通道经皮肾镜（PCNL）治疗多发性肾结石（结石体积25mm）11例，术前均行KUB平片、IVP检查及CT检查，术后3天复查KUB或CT检查以明确结石排出情况及是否残留结石。结果:上尿路结石患者共47例，第一次手术成功进镜39例，一次进镜成功率82.9％（39/47）。碎石时间35～160（86.54±30.50）min。一次性清除结石33例（84.6％）。未能发现结石或者未能进入输尿管导致手术失败患者8例，其中2例因输尿管屈曲严重，肾盂肾盏漏斗样成角过大，钬激光无法接触到结石，导致碎石失败。因输尿管狭窄并且狭窄段多发或较长，无法行输尿管狭窄段切开，未达到结石所在部位而失败6例。6例因结石过大，行二期输尿管软镜手术，均碎石成功。术后2例患者出现发热、腹部不适、膀胱刺激征等感染症状，经尿培养及药敏试验检查后，应用抗感染药物后痊愈。统计我科同类结石病例（结石体积20mm）35例行ESWL治疗，行ESWL1次治疗示结石排净率60.0%（21/35），行χ2检验，α=0.05，χ2=8.173，P=0.0040.05表示差异有统计学意义。行ESWL2次治疗示结石排净率65.7%（23/35），行χ2检验，α=0.05，χ2=5.735，P=0.0170.05两组间的差异存在统计学意义.行ESWL3次治疗示结石排净率68.6%（24/35），行χ2检验，α=0.05，χ2=4.636，P=0.0310.05两组间的差异存在统计学意义经电子输尿管软镜检出上尿路疾病共17例，检查结果如下所示：肾盂及肾盏肿瘤6例，输尿管息肉2例，肾乳头肥大1例。另有上尿路静脉曲张破裂导致活动性出血3例，血凝块2例,仅发现粘膜充血2例；1例因出血视野不清而未能进行检查。电子输尿管软镜联合单通道PCNL治疗多发性肾结石11例，碎石成功率81.8%（9/11），2例术后复查CT可见6mm及4mm大小结石残留。结论:应用电子输尿管软镜诊断和治疗上尿路疾病是一种安全有效的方法，对于上尿路结石的诊疗，明确性质不明的上段输尿管、肾集合系统病灶和不明原因血尿的具有重要的临床意义。
[Abstract]:Objective: to observe the effect of electronic ureteroscopy combined with holmium laser in the treatment of upper urinary tract diseases. Methods: from January 2012 to December 2013, 64 cases of upper urinary tract diseases were treated with soft ureteroscopy, including 47 cases of upper urinary calculi (stone volume < 20mm), 13 cases of upper ureteral calculi and 34 cases of renal calculi. In order to detect the stone drainage rate, KUB or urinary tract CT.17 cases of non-calculous upper urinary tract diseases were examined at 3 days, 1 month and 3 months after operation, and 17 cases of non-calculous upper urinary tract diseases were counted. To observe the curative effect, 11 cases of multiple renal calculi (25 mm stone volume) were treated by electronic ureteroscopy combined with single channel percutaneous nephroscopy (PCNL). KUB plain film and CT examination were performed before operation. KUB or CT examination was performed 3 days after operation to determine whether stone excretion and residual stones. Results: there were 47 patients with upper urinary calculi, 39 of whom were successfully treated by the first operation, and the success rate of one operation was 82.9 / 47. The lithotripsy time was 35 ~ 160 卤86.54 卤30.50 min. 33 cases of stones were removed at one time, and 84.6% of the patients were not found stones or failed to enter the ureter, which resulted in the failure of operation in 8 cases. Because of severe ureteral flexion, the renal pelvis and calyceal funnel angle was too large and holmium laser could not reach the stone, which resulted in the failure of lithotripsy. Because of ureteral stricture and multiple or long ureteral stricture, ureteral stricture segment incision could not be performed. 6 cases failed because the stones were too large, all of them were successfully treated with secondary soft ureteroscopy. 2 cases had symptoms of infection such as fever, abdominal discomfort, bladder irritation and so on. After urine culture and drug sensitivity test, the patients were cured by anti-infective drugs. We counted the same type of lithiasis cases (20mm stone volume and 35 cases of ESWL treatment) in our department. The rate of stone removal was 60.021 / 35% after ESWL1 treatment, 蠂 ~ 2 test was performed, 伪 0.05, 蠂 ~ 2 8.173%, P ~ (0.0040.05) showed significant difference. The rate of stone removal was 65.7% ~ 35%, 蠂 ~ 2 test, 伪 0.05, 蠂 ~ (25) 735P ~ (0.017) P ~ (0.05). There was statistical significance between the two groups. 68.6% 24 / 35%, 蠂 2 test showed that there were 17 cases of upper urinary tract diseases detected by soft electron ureteroscopy. The difference between the two groups was statistically significant, 伪 0.05 and 蠂 2 4.636P 0.0310.05, respectively. The results were as follows: 6 cases of renal pelvis and calyceal tumor, 2 cases of ureteral polyp, 1 case of renal papilla hypertrophy, 3 cases of active bleeding caused by rupture of upper urinary vein, 2 cases of blood clot. Only 2 cases of mucosal congestion could not be examined because of unclear visual field of hemorrhage, 11 cases of multiple renal calculi were treated by electronic ureteroscope combined with single channel PCNL. The success rate of lithotripsy was 81.8% / 11% in 2 cases. After operation, 6mm and 4mm residual stones were found on CT. Conclusion: it is a safe and effective method to diagnose and treat upper urinary tract diseases by using electronic soft ureteroscopy. For the diagnosis and treatment of upper ureteral calculi, the upper ureter with unknown nature is clearly defined. The focus of renal collecting system and unknown hematuria have important clinical significance.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699

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