三种手术方式急诊处理输尿管结石致急性梗阻性肾损伤的回顾性临床分析

发布时间：2018-04-10 13:45

本文选题：输尿管结石 + 急性肾损伤　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨输尿管逆行插管术、经皮肾穿刺造瘘术及输尿管镜碎石术对输尿管结石致急性梗阻性肾损伤的急诊手术治疗的有效性及安全性。方法:回顾性分析2012年1月至2016年12月期间在广西医科大学第一附属医院泌尿外科住院治疗的101例输尿管结石致急性梗阻性肾损伤患者的临床资料。101例患者入院24小时内均行手术治疗,其中行输尿管逆行插管术60例,经皮肾造瘘术20例,输尿管镜碎石术21例。统计手术成功率,手术时间、术中出血量、术后并发症、I期住院时间、术前、术后1天,3天、1周、1月血尿素氮、肌酐值等资料,然后对数据进行分析,用于评估及比较。结果:本组101例患者中轻度肾积水81例,URSL组与输尿管逆行插管组、PCN组术前一般情况比较,具有病程短,入院肌酐值低,尿镜下白细胞、血常规白细胞、中性粒百分比低,差异具有统计学意义,输尿逆行插管组和PCNL组术前一般情况比较,差异无统计学意义。输尿管逆行插管术组、经皮肾穿刺造瘘术组、URSL组解除梗阻成功率分别为75.81%、100%、100%,PCN解除梗阻成功率较输尿管逆行插管术高,且差异具有统计学意义(P0.05);中-重度肾积水20例,输尿管逆行插管术组、PCN组术前一般情况无差异,解除梗阻成功率分别为52.38%、100%,PCN成功率较输尿管逆行插管术成功率高,且差异具有统计学意义(p0.05)。三组手术时间差异无统计学意义,但手术出血量、I期住院时间,PCN组较输尿管逆行插管组、URSL组高,且差异具有统计学意义(P0.01)。并发症方面,输尿管逆行插管术组发生率5.00%(3/60),严重并发症1例(1.67%),PCN组发生率23.07%(6/26),严重并发症2例(7.69%)。URSL组发生率14.29%(3/21),PCN组与输尿管逆行插管术组比较,并发症发生率高,且差异具有统计学意义(P0.05),而URSL组与PCN组、输尿管逆行插管组比较,差异无统计学意义(P0.05)。101例患者中最终手术成功解除梗阻87例,14例行血液透析治疗,2-5天后行相关碎石手术。解除梗阻后肾功能迅速恢复,输尿管逆行插管术组、PCN组、URSL组、血液透析+碎石组术后1月肾功能恢复情况(BUN、SCr)比较,差异无统计学意义(P0.05)。结论:1、输尿管逆行插管术、PCN、URSL在处理输尿管结石致AKI,均是安全、有效的应急治疗手段。2、对于输尿管结石致AKI合并严重尿路感染者,首选输尿管逆行插管术,其次PCN。3、对于病程短,无尿路感染及严重合并症者,URSL治疗输尿管结石致AKI具有结石清除率高,免除II期碎石、严重并发症少的优点。
[Abstract]:Objective: to evaluate the efficacy and safety of retrograde ureteral catheterization percutaneous nephrostomy and ureteroscopic lithotripsy for acute obstructive renal injury caused by ureteral calculi.Methods: the clinical data of 101 patients with acute obstructive renal injury caused by ureteral calculi from January 2012 to December 2016 were analyzed retrospectively. 101 patients were hospitalized in Urology Department, first affiliated Hospital of Guangxi Medical University.All patients received surgical treatment within 24 hours.Among them, 60 cases underwent retrograde ureteral catheterization, 20 cases underwent percutaneous nephrostomy and 21 cases underwent ureteroscopic lithotripsy.The data of success rate, operation time, intraoperative bleeding volume, postoperative complications and hospitalization time of stage I, preoperative, postoperative 1 day, 3 days, 1 week, 1 month blood urea nitrogen, creatinine value, etc., were analyzed and used for evaluation and comparison.Results: among the 101 patients with mild hydronephrosis, 81 cases with mild hydronephrosis were compared with retrograde ureteral catheterization group (PCN group). The patients had shorter course of disease, lower creatinine in admission, lower percentage of white blood cells, blood routine leukocytes and neutrophils.The difference was statistically significant. There was no significant difference between retrograde catheterization group and PCNL group before operation.In the retrograde ureteral catheterization group, the success rate of relieving obstruction in the URSL group was higher than that in the ureteral retrograde catheterization group (75.81%), and the difference was statistically significant (P 0.05), and 20 cases of moderate to severe hydronephrosis.There was no difference before operation in PCN group. The success rate of relieving obstruction was 52.38%. The success rate of PCN was higher than that of retrograde ureteral catheterization, and the difference was statistically significant (P 0.05).There was no significant difference in operative time among the three groups, but the hospitalization time of PCN group was higher than that of ureteral retrograde catheterization group (P 0.01).In terms of complications, the incidence of retrograde ureteral intubation group was 5.00 / 60, severe complication was 1 case, the incidence of severe complication was 23.077 / 26% in PCN group, and the incidence rate of severe complication was 14.29% 321% PCN group compared with retrograde ureteral catheterization group, the incidence rate of serious complication group was higher than that of retrograde ureteral catheterization group.There was no significant difference between URSL group, PCN group and retrograde ureteral catheterization group. Among the 101 cases, 87 cases were successfully relieved of obstruction and 14 cases were treated with hemodialysis for 2 to 5 days.The renal function recovered rapidly after relieving obstruction. There was no significant difference in the recovery of renal function between PCN group and URSL group and hemodialysis lithotripsy group (P 0.05).Conclusion Retrograde ureteral catheterization is a safe and effective emergency treatment for ureteral calculi. Ureteral retrograde catheterization is the first choice for ureteral calculus-induced AKI complicated with severe urinary tract infection, followed by PCN.3, and the course of disease is short.Ureteral calculi in patients without urinary tract infection and severe complications have the advantages of high stone clearance rate, no stage II lithotripsy, and less serious complications.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.4

【参考文献】