经尿道Peel-away鞘输尿管镜与经尿道输尿管镜治疗膀胱结石的疗效比较

发布时间：2018-06-20 05:35

本文选题：膀胱结石 + Peel-away鞘　；参考：《中国内镜杂志》2017年10期

【摘要】：目的比较经尿道Peel-away鞘输尿管镜与经尿道输尿管镜治疗膀胱结石的效果。方法将该科2013年1月-2015年12月76例膀胱结石按随机原则分为:A组(经尿道Peel-away鞘输尿管镜膀胱碎石术)45例;B组(经尿道输尿管镜膀胱碎石术)31例。结果 76例膀胱结石均获一次性碎石取石成功。碎石时间:A组(17.8±5.9)min,B组(22.7±8.3)min,差异有统计学意义(t=2.96,P=0.004);清石时间:A组(12.6±4.9)min,B组(24.5±5.3)min,差异有统计学意义(t=9.90,P=0.000);术中尿道黏膜损伤:A组(1.0±0.5)分,B组(2.1±0.4)分,差异有统计学意义(t=9.47,P=0.000);VAS评分:A组(1.9±0.6)分,B组(2.6±0.6)分,差异有统计学意义(t=4.72,P=0.000);留置导尿管时间:A组(1.0±0.2)d,B组(1.4±0.9)d,差异有统计学意义(t=2.59,P=0.012);住院费用:A组(7 437.4±356.7)元,B组(7 296.8±333.8)元,差异无统计学意义(t=-1.73,P=0.087)。两组术中无膀胱大出血、穿孔和破裂等并发症,无中转开放手术。术后并发症:B组发生术后泌尿系感染1例,经口服抗生素治疗后痊愈;A组发生术后尿潴留1例,B组5例,差异有统计学意义(χ2=6.43,P=0.011)。随访情况:失访13例,余63例随访6~12个月,两组各有1例老年男性患者因前列腺增生导致尿潴留;余患者均无再发结石,无尿道狭窄。通过统计分析结果,发现A组在碎石时间、清石时间、尿道黏膜损伤、术后疼痛和术后留置导尿管时间等方面较B组具有明显优势。结论经尿道Peel-away鞘输尿管镜与经尿道输尿管镜治疗膀胱结石疗效无明显差异。经尿道Peel-away鞘输尿管镜在碎石时间、清石时间及避免术中损伤尿道黏膜方面更优,两组手术费用无明显差异。经尿道Peel-away鞘输尿管镜是一种值得推广的内镜膀胱碎石手术方法。
[Abstract]:Objective to compare the efficacy of transurethral Peel-away ureteroscopy and transurethral ureteroscopy in the treatment of bladder calculi. Methods from January 2013 to December 2015, 76 cases of bladder calculi were randomly divided into two groups: group A (45 cases with transurethral Peel-away ureteroscopic cystolithotripsy) and group B (31 cases with transurethral ureteroscopic cystolithotripsy). Results 76 cases of bladder stones were successfully removed by one-time lithotripsy. The lithotripsy time was 17.8 卤5.9 min in group B and 22.7 卤8.3 min in group B, the difference was statistically significant (t = 2.96, P = 0.004), and the time of lithotomy in group A was 12.6 卤4.9 min, the difference was statistically significant (t 9.90 P 0.000), and the score of urethral mucosal injury in group A was 1.0 卤0.5, and the score of VAS score in group B was 2.1 卤0.4), the VAS score of group A was 1.9 卤0.6) and that of group B was 2.6 卤0.6, respectively. The time of indwelling urethral catheter in group A was 1. 0 卤0. 2 卤0. 9 days, the difference was statistically significant, and the cost of hospitalization in group A was 7 437.4 卤35. 7) RMB 7 296.8 卤333. 8) in group B, there was no significant difference between 1. 73 and 0. 0877.The difference was not significant (P < 0. 087), but there was no significant difference in the time of indwelling urethral catheter in group A (1. 0 卤0. 2 卤0. 9 卤0. 012 卤0. 012), and the cost of hospitalization in group A was 7 437.4 卤35. 7) in group B, there was no significant difference. There were no complications such as massive bladder hemorrhage, perforation and rupture, and no conversion to open surgery in both groups. Postoperative complications occurred in 1 case of urinary tract infection in group B and 5 cases of postoperative urinary retention in group A after oral antibiotic therapy. The difference was statistically significant (蠂 ~ 2 = 6.43). Follow up: 13 cases were lost and 63 cases were followed up for 6 ~ 12 months. In each group, one elderly male patient caused urinary retention due to prostatic hyperplasia, and none of the remaining patients had recurrent stones and urethral stricture. The results of statistical analysis showed that group A had obvious advantages over group B in lithotripsy time, lithotomy time, urethral mucosal injury, postoperative pain and time of indwelling catheter. Conclusion there is no significant difference between transurethral Peel-away ureteroscopy and transurethral ureteroscopy in the treatment of bladder calculi. The transurethral Peel-away ureteroscopy was better in lithotripsy time, lithotomy time and avoiding urethral mucous membrane injury. There was no significant difference between the two groups in the cost of operation. Transurethral Peel-away sheath ureteroscopy is a method worth popularizing endoscopic bladder lithotripsy.
【作者单位】：中南大学湘雅医院国际医疗部;湖南省株洲市三三一医院泌尿外科;
【分类号】：R699

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