输尿管镜钬激光与开放手术治疗良性输尿管狭窄的近期疗效对比研究

发布时间：2018-05-02 11:18

本文选题：输尿管狭窄 + 输尿管镜　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:本文通过输尿管镜钬激光与开放手术两种方法治疗良性US进行研究,比较两种手术方案治疗US的治疗效果,探讨输尿管镜钬激光在临床中治疗良性US的优势。研究方案:回顾性分析吉林大学中日联谊医院泌尿外科自2014年9月-2016年8月收治的54例良性US的临床资料。术前结合患者病史以及完善相关辅助检查,用以明确形成US的原因,部位以及性质。确保所有患者均为单侧单发的小于2cm的良性US,且并排除受外源性压迫。根据患者自愿原则进行分组,将输尿管镜钬激光狭窄内切开设为观察组,共计26人,其中男性19人,女性7人,年龄45.39±9.11岁,狭窄位于输尿管上段12人,中段8人,下段6人,狭窄长度为1.25±0.44cm,狭窄时间为11.90±2.56个月,肾盂分离程度为2.80±0.49cm;将开放手术治疗设为对照组,共计28人,其中男性20人,女性8人,年龄46.54±9.99岁,狭窄位于输尿管上段10人,中段10人,下段8人,狭窄长度为1.36±0.44cm,狭窄时间为13.04±3.44个月,肾盂分离程度为3.01±0.36cm。研究结果:两组手术均按照计划成功完成且术中证实US均为良性病变。通过术后随访6个月得出,观察组手术治疗有效20人,无效4人,有效率为76.92%;对照组手术治疗有效24人,无效4人,有效率为85.71%。经统计学分析,通过不两种不同的手术方式治疗同一种疾病的有效率无统计学差异(即p0.05)。观察组手术耗时52.12±11.91min;对照组手术耗时80.03.12±9.78min,两者差异有统计学意义(p0.01)。观察组手术出血量为12.46±2.70ml;对照组手术出血量为177.34±10.70ml,两者差异有统计学意义(p0.01)。观察组胃肠道恢复时间2.52±0.26天;对照组胃肠道恢复时间5.42±0.42天,两者差异有统计学意义(p0.01)。观察组术后住院5.31±0.34天;对照组术后住院9.11±0.29天。两者差异有统计学意义(p0.01)。观察组术后留置尿管4.42±0.35天;观察组留置尿管8.30±0.29天,两者差异有统计学意义(p0.01)。观察组术后患者无出现高热0例,明显疼痛3例,血尿6例,输尿管瘘1,腹胀1例,并发症发生率为42.31%;对照组术后患者无出现高热2例,明显疼痛6例,血尿9例,输尿管瘘2,腹胀3例,并发症发生率为78.57%;经X2检查得出p=0.0060.05,即两者差异有统计学意义。研究结论:1.对于小于2cm的非缺血性以及非受外源性压迫的单侧单发良性US,采用输尿管镜钬激光与开放手术治疗取得相似的成功率和有效率。2.相比于开放手术,输尿管镜钬激光狭窄内切开术具有更短的手术时间,术中出血更少,胃肠道恢复时间更快,平均住院日更短,术后并发症更少的优势,更容易为患者所接受。
[Abstract]:Objective: to compare the therapeutic effects of ureteroscopic holmium laser and open surgery in the treatment of benign US, and to explore the advantages of ureteroscopic holmium laser in the treatment of benign US. Research scheme: the clinical data of 54 cases of benign US admitted from September 2014 to August 2016 were retrospectively analyzed in the Department of Urology, Sino-Japanese Friendship Hospital of Jilin University. To determine the cause, location and nature of US, combined with patient history and related auxiliary examination. Ensure that all patients have unilateral benign USS less than 2cm and are excluded from external compression. According to the voluntary principle of the patients, the ureteroscopic holmium laser stenosis was divided into observation group (n = 26), including 19 males and 7 females, aged 45.39 卤9.11 years, 12 patients with ureteral stenosis located in the upper ureter, 8 patients in the middle segment, and 6 patients in the lower ureteral segment. The length of stenosis was 1.25 卤0.44 cm, the time of stenosis was 11.90 卤2.56 months, and the degree of renal pelvis separation was 2.80 卤0.49 cm. The length of stenosis was 1.36 卤0.44 cm, the time of stenosis was 13.04 卤3.44 months, and the degree of separation of renal pelvis was 3.01 卤0.36 cm. Results: both groups were successfully performed according to plan and US was confirmed as benign lesions during operation. The results showed that the effective rate was 76.92 in the observation group, and the effective rate was 85.71 in 24 patients and 4 patients in the control group. By statistical analysis, there was no statistical difference in the effective rate of treating the same disease by two different surgical methods (p0.05). The operative time was 52.12 卤11.91 min in the observation group and 80.03.12 卤9.78 min in the control group (P < 0.01). The amount of operative bleeding was 12.46 卤2.70 ml in the observation group and 177.34 卤10.70 ml in the control group (P < 0.01). The recovery time of gastrointestinal tract was 2.52 卤0.26 days in the observation group and 5.42 卤0.42 days in the control group. The postoperative hospitalization in the observation group was 5.31 卤0.34 days and in the control group was 9.11 卤0.29 days. The difference was statistically significant (P 0.01). In the observation group, the indwelling catheter was 4.42 卤0.35 days after operation, and the observation group was 8.30 卤0.29 days. The difference between the two groups was statistically significant (p 0.01). In the observation group, there were no hyperpyrexia in 0 cases, obvious pain in 3 cases, hematuria in 6 cases, ureteral fistula in 1 case, abdominal distension in 1 case, complication rate was 42.31%, in the control group, there were no hyperthermia in 2 cases, obvious pain in 6 cases, hematuria in 9 cases. There were 2 ureteral fistula and 3 abdominal distention, the incidence of complications was 78.57.The result of X2 examination showed that p0. 0060.05, that is, the difference was statistically significant. Conclusion: 1. The successful rate and effective rate of ureteroscopic holmium laser and open surgery were similar to those of non-ischemic and unilateral benign USS which were less than 2cm and were not subjected to external compression. Compared with open operation, ureteroscopic holmium laser stenosis endotomy has the advantages of shorter operative time, less intraoperative bleeding, faster gastrointestinal recovery time, shorter average hospital stay, less postoperative complications, and more easily accepted by patients.
【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】：R699.4

【相似文献】