逆行输尿管软镜与经皮肾镜治疗2-3cm肾盂结石：单中心随机对照研究

发布时间：2018-04-30 17:43

  本文选题：肾盂结石 + 输尿管软镜　； 参考：《浙江大学》2014年硕士论文

【摘要】：目的： 比较逆行输尿管软镜下钬激光碎石术(FURS)与经皮肾镜钬激光碎石术(PCNL)治疗2-3cm肾盂结石的临床疗效、安全性和费用。 方法： 邵逸夫医院2011.3-2014.2期间100例单发的2-3cm肾盂结石患者纳入本研究：随机分为两组：输尿管软镜组50例,经皮肾镜组50例。观察指标：结石清除率、手术时间、术中出血量、输血百分比、术后血红蛋白下降及超敏反应蛋白CRP上升量、术后止痛药物使用率、术后并发症发生率、术后住院时间、总治疗费用。 结果： 输尿管软镜组与经皮肾镜组在术中出血量上分别为(15.5±1.6)ml与(86.7±13.1)ml；输血百分比分别为0%(0/50)与8%(4/50)；术后血红蛋白下降量分别为(0.9±0.1)g/L与(1.3±0.2)g/L；术后超敏反应蛋白CRP上升量分别为(3.7±1.1)mg/L与(18.7±5.4)mg/L；术后止痛药物使用率分别为12%(6/50)：34%(17/50)；术后住院时间分别为(2.7±0.2)天与(6.0±0.3)天；并发症(Clavien分级Ⅱ级)发生率分别为4%(2/50)和12%(6/50)；总治疗费用分别为(23.67±0.61)千元与(27.70±0.81)千元；以上指标差异均在统计学上有意义(P0.05)。结石清除率(残石≤4mm)分别为92%(46/50)与94%(47/50)；手术时间分别为(83.1±4.4)min与(97.3±5.9)min；以上指标差异在统计学上无意义(P0.05)。输尿管软镜组在术中出血量、输血百分比、术后血红蛋白下降及CRP上升量、术后住院时间、术后并发症发生率、总费用上优于经皮肾镜组；在结石清除率、手术时间上与经皮肾镜无明显差异。 结论 相比PCNL,输尿管软镜下钬激光碎石在治疗2-3cm单发肾盂结石上具有相似的结石清除率,且有损伤小、出血少、并发症发生率低、术后恢复快、花费少等优势。因此,输尿管软镜有望成为治疗2-3cm肾盂结石的主要手术方式之一。
[Abstract]:Objective: To compare the efficacy, safety and cost of retrograde ureteroscopic holmium: YAG laser lithotripsy with percutaneous nephrolithotripsy in the treatment of 2-3cm pyelolithiasis. Methods: In this study, 100 patients with 2-3cm pyelolithiasis were randomly divided into two groups: soft ureteroscopy group (n = 50) and percutaneous nephroscopy group (n = 50). Outcome measures: stone clearance rate, operative time, intraoperative bleeding volume, percentage of blood transfusion, decrease of hemoglobin and increase of hypersensitive reactive protein CRP, postoperative analgesic drug utilization rate, postoperative complication rate, postoperative hospitalization time, Total cost of treatment. Results: In the soft ureteroscopy group and the percutaneous nephroscope group, the intraoperative bleeding volumes were 15.5 卤1.6)ml and 86.7 卤13.1 ml, respectively; the percentages of blood transfusion were 0: 0 / 50) and 8 / 50 respectively; the postoperative hemoglobin decreased by 0.9 卤0.1)g/L and 1.3 卤0.2g / L, respectively; the increase of postoperative hypersensitivity protein CRP was 3.7 卤1.1)mg/L and 18.7 卤5.4 mg / L, respectively. The utilization rate of posterior analgesic drugs was 12 / 50: 17 / 50, respectively, and the postoperative hospital stay was 2.7 卤0.2 days and 6.0 卤0.3 days, respectively. The incidence of complications of Clavien grade 鈪，

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