输尿管软镜下钬激光碎石治疗肾结石的临床疗效及安全性
发布时间：2018-08-11 15:47
【摘要】：目的泌尿系结石在泌尿外科中属于常见病,其发病率高,影响人群广泛。研究表明,泌尿系结石疾病在世界范围内约有5-15%的患者,其中中国国内的患者约占1-5%。肾结石是泌尿结石中最常见的结石,其发病时的疼痛程度在泌尿结石中也最高。随着时代的进步发展,当今快节奏生活使得众多上班族人去无暇饮水、长期久坐,加之以现代生活中的长期不规律的生活方式,这使得肾结石的发病情况再近年来有不断增长,且呈年轻化发病的趋势。长期未得及时治疗的肾结石会给人肾脏功能造成一系列的危害,其不仅会导致结石在肾盂输尿管连接处停留从而引起尿路梗阻,而且会给患者带来相当程度的疼痛感,同时还会影响人机体的其他功能,诸如引起肾功能丧失,严重者还可引发尿毒症。肾结石患者体内肾组织会逐步为脂肪组织所代替,在一些严重病例中,患者的肾组织所剩极少,甚至可完全消失。长期得不到治疗的肾结石最终可发展为肾功能衰竭,危及患者的生命。同时结石通常含有多种病菌等病原体,其长期存在易引发肾脏感染、肾积水等从而导致肾积脓,相反尿路感染又可使结石并且加重,严重者可引发败血病。近年来,随着医疗科技的发展进步,输尿管软镜技术得到了迅速的发展。输尿管软镜技术通过泌尿外科理念与工业设计的融合,极大的推动了泌尿疾病治疗方法的发展。诸如电子镜、钬激光、机器人辅助输尿管软镜、一次性输尿管软镜、末端可弯输尿管硬镜、双通道输尿管软镜等一系列新设备的应用也极大推动了泌尿疾病的治疗发展,让患者与术者均获益匪浅。然而,虽然已有诸多研究关注输尿管软镜下钬激光碎石术的治疗效果,但作为一项新技术,更多的临床评估资料依然可以为肾结石的治疗以及输尿管软镜下钬激光碎石术疗效的确切性提供更为坚实的临床依据。本研究拟通过回顾性分析2015年3月至2016年2月期间来我院行输尿管软镜钬激光碎石术治疗肾结石的患者情况,通过统计分析患者单次进镜成功率、结石寻及率、结石总清除率、手术时间、术中出血量,术后住院天数及并发症情况,评价输尿管软镜钬激光碎石术治疗肾结石的临床疗效及安全性。方法回顾性分析自2015年3月至2016年内2月期间来浙江大学医学院附属第一医院行输尿管软镜钬激光碎石术治疗肾结石的患者共计48例。其中男29例,女19例,年龄范围22～65岁,平均年龄44.9±8.51岁,病程2-40天,平均病程14.35±6.72天。48例患者中,35例因不同程度的腰背或腰腹疼痛就诊;6例因肉眼可见血尿就诊;其余7例无明显症状的患者经体检发现肾结石而就诊。患者均经B超、KUB、CT等影像学检查确认为肾结石。所有患者均为单侧结石,其中左肾结石26例,右肾结石22例。结石位置为肾上盏结石15例,肾中盏结石21例,肾下盏结石12例。结石最长直径2.1cm-5.5cm,平均直径2.82±0.96cm。所有患者中5例未行过体外冲击波碎石,43例患者曾行体外冲击波碎石1-3次。研究排除患有严重心肺疾病或肝肾功能障碍者;有影响肾功能疾病,如糖尿病、慢性肾炎、高血压等的患者;泌尿系统感染、肾脏积水严重、尿道狭窄及鹿角状结石患者以及其他严重全身性疾病患者。采用输尿管软镜钬激光碎石术碎石,术后3日复查KUB明确碎石效果及双J管位置,出院1月复查KUB确定有误结石残留,结石清除者拔除双J管,未清除者可行2次治疗。术中记录手术时间、清石率、术中出血量等。术后统计患者住院天数术、留置导尿管时间及并发症情况。术后2天及1个月,根据患者KUB检查或平扫CT结果判断碎石清除情况。统计分析患者单次进镜成功率、结石寻及率、结石总清除率、手术时间、术中出血量,术后住院天数及并发症情况。结果1.不同结石位置的患者术中情况统计结果表明,不同组患者平均手术时间上,肾上盏结石患者及肾中盏结石患者其平均手术时间无显著差异,P0.05;而肾下盏结石患者手术时间显著高于肾上盏及中盏患者,差异具有统计学意义,P0.05。三组患者在平均术中出血量上均无显著差异。2.所有患者中共有40例(83%)患者单次进镜成功,其中肾上盏患者13例(87%)单次进镜成功,肾中盏患者18例(86%)单次进镜成功,肾下盏患者9例(75%)单次进镜成功。肾下盏患者的单次进镜成功率显著低于肾上盏及中盏患者,差异具有统计学意义,P0.05肾上盏与肾中盏患者单次进镜成功率没有显著差异,P0.05。所有患者均寻及结石。3.48例患者中,共有41例(85%)患者一次清除结石,其中肾上盏中14例(93%)一次清除,1例有残留;中盏患者中19例(90%)一次清除,2例残留;下盏患者中8例(67%)一次清除,4例残留。肾下盏清除率显著低于上盏及中盏,差异具有统计学意义,P0.05。肾上盏及中盏患者结石清除率没有显著差异,P0.05。4.患者住院时间1～8天,平均住院时间3.21±0.73天;留置尿管时间1～2天,平均留置时间1.72±0.33天,支架管拔除时间15～30天,平均29.45±3.42天。所有患者术后情况良好,其中术后发热5例(10%),术后患侧腰疼6例(13%),术后血尿3例(6),无严重并发症。结论1.输尿管软镜钬激光碎石术在治疗肾结石中具有良好的治疗效果,其清石率高、手术时间短;2.输尿管软镜钬激光碎石术在治疗肾结石中具有良好的安全性,患者恢复快,术后无严重并发症;3.输尿管软镜钬激光碎石术在肾结石治疗中有着良好的临床效果和安全性,是治疗肾结石的可靠方法。
[Abstract]:Objective Urolithiasis is a common disease in urology, which has a high incidence and affects a wide range of people. Studies have shown that 5-15% of the patients with urolithiasis worldwide, including 1-5% of the patients in China. Kidney stones are the most common urolithiasis, and the degree of pain during the onset of the disease is also the greatest in urolithiasis. Gao. With the progress of the times, the fast-paced life nowadays makes many working people have no time to drink water, long-term sedentary, coupled with the long-term irregular lifestyle in modern life, which makes the incidence of kidney stones in recent years has increased, and the trend of younger onset. Long-term untreated kidney stones will give rise to. Human kidney function causes a series of hazards, which not only causes stones to stay at the ureteropelvic junction and cause urinary tract obstruction, but also gives patients a considerable degree of pain, and also affects other functions of the human body, such as kidney loss, serious cases can also lead to uremia. In some serious cases, the kidney tissue remains very little, or even completely disappears. Long-term untreated kidney stones can eventually develop into renal failure, endangering the lives of patients. At the same time, stones usually contain a variety of pathogens, such as bacteria, which are prone to long-term renal infection, nephrosis. In recent years, with the development of medical science and technology, ureteroscopic technology has been rapidly developed. The ureteroscopic technology has greatly promoted the treatment of urinary diseases through the integration of urological concept and industrial design. The development of methods, such as electronic microscopy, holmium laser, robotic assisted ureteroscope, disposable ureteroscope, end-bendable ureteroscope, dual-channel ureteroscope, and a series of new devices have also greatly promoted the development of treatment of urinary diseases, so that patients and surgeons benefit greatly. However, as a new technique, more clinical evaluation data can still provide a more solid clinical basis for the treatment of renal calculi and the accuracy of the efficacy of flexible ureteroscopic holmium laser lithotripsy. This study is to retrospectively analyze the period from March 2015 to December 2016. The clinical efficacy and safety of holmium laser lithotripsy with flexible ureteroscope in the treatment of renal calculi in our hospital were evaluated by statistical analysis of the success rate of single endoscopic lithotripsy, stone finding rate, total stone clearance rate, operative time, intraoperative bleeding volume, postoperative hospital stay and complications. Methods From March 2015 to February 2016, 48 patients with renal calculi underwent flexible ureteroscopic holmium laser lithotripsy in the First Affiliated Hospital of Medical College of Zhejiang University were analyzed retrospectively. Among them, 29 were males and 19 were females. The age ranged from 22 to 65 years, with an average age of 44.9 (+ 8.51) years and a course of 2 to 40 days, with an average duration of 14.35 (+ 6.72) days. Among them, 35 cases were diagnosed with low back or abdominal pain, 6 cases with visible hematuria, and 7 cases without obvious symptoms were diagnosed with renal calculi by physical examination. Fifteen upper calyx stones, 21 middle calyx stones, and 12 lower calyx stones were located. The longest diameter of the stones was 2.1 cm-5.5 cm, with an average diameter of 2.82 (+ 0.96 cm). Five of the patients did not undergo extracorporeal shock wave lithotripsy and 43 had undergone extracorporeal shock wave lithotripsy. Can disease, such as diabetes, chronic nephritis, hypertension and other patients; urinary tract infection, serious hydronephrosis, urethral stricture and staghorn calculi patients and other serious systemic disease patients. Use ureteroscopic holmium laser lithotripsy ureteroscopic lithotripsy, 3 days after surgery to determine the effect of lithotripsy KUB and double J-tube location, 1 month after discharge to determine KUB. The operation time, stone removal rate and bleeding volume during operation were recorded. The hospitalization days, indwelling catheter time and complications were counted after operation. The lithotripsy was judged according to KUB or plain CT results 2 days and 1 month after operation. The success rate of single endoscopy, stone finding rate, total stone clearance rate, operation time, intraoperative bleeding volume, postoperative hospital stay and complications were analyzed. Results 1. The results showed that the average operation time of patients with upper calyceal calculi and calyceal calculi in different stone positions were different. There was no significant difference (P 0.05), but the operation time of inferior calyx stone patients was significantly longer than that of upper calyx and middle calyx patients, the difference was statistically significant (P 0.05). Eighteen patients (86%) had a successful single endoscopy, and nine patients (75%) had a successful single endoscopy. The success rate of single endoscopy in inferior calyx was significantly lower than that in upper calyx and middle calyx. The difference was statistically significant. There was no significant difference in the success rate of single endoscopy between upper calyx and middle calyx (P 0.05). Of the 48 patients, 41 (85%) had one stone removal, of which 14 (93%) had one stone removal from the upper calyx and 1 residue; 19 (90%) had one stone removal from the middle calyx and 2 residue from the lower calyx; 8 (67%) had one stone removal from the lower calyx and 4 residue from the middle calyx. There was no significant difference in stone clearance rate between the two groups (P There were 6 cases of low back pain (13%) and 3 cases of postoperative hematuria (6) without serious complications. Conclusion 1. Ureteroscopic holmium laser lithotripsy has a good therapeutic effect in the treatment of renal calculi, with a high stone clearance rate and a short operation time; 2. Ureteroscopic holmium laser lithotripsy has a good safety in the treatment of renal calculi, rapid recovery and no serious complications. 3. Ureteroscopic holmium laser lithotripsy has good clinical effect and safety in the treatment of renal calculi. It is a reliable method for the treatment of renal calculi.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.2
，
本文编号：2177442
[Abstract]:Objective Urolithiasis is a common disease in urology, which has a high incidence and affects a wide range of people. Studies have shown that 5-15% of the patients with urolithiasis worldwide, including 1-5% of the patients in China. Kidney stones are the most common urolithiasis, and the degree of pain during the onset of the disease is also the greatest in urolithiasis. Gao. With the progress of the times, the fast-paced life nowadays makes many working people have no time to drink water, long-term sedentary, coupled with the long-term irregular lifestyle in modern life, which makes the incidence of kidney stones in recent years has increased, and the trend of younger onset. Long-term untreated kidney stones will give rise to. Human kidney function causes a series of hazards, which not only causes stones to stay at the ureteropelvic junction and cause urinary tract obstruction, but also gives patients a considerable degree of pain, and also affects other functions of the human body, such as kidney loss, serious cases can also lead to uremia. In some serious cases, the kidney tissue remains very little, or even completely disappears. Long-term untreated kidney stones can eventually develop into renal failure, endangering the lives of patients. At the same time, stones usually contain a variety of pathogens, such as bacteria, which are prone to long-term renal infection, nephrosis. In recent years, with the development of medical science and technology, ureteroscopic technology has been rapidly developed. The ureteroscopic technology has greatly promoted the treatment of urinary diseases through the integration of urological concept and industrial design. The development of methods, such as electronic microscopy, holmium laser, robotic assisted ureteroscope, disposable ureteroscope, end-bendable ureteroscope, dual-channel ureteroscope, and a series of new devices have also greatly promoted the development of treatment of urinary diseases, so that patients and surgeons benefit greatly. However, as a new technique, more clinical evaluation data can still provide a more solid clinical basis for the treatment of renal calculi and the accuracy of the efficacy of flexible ureteroscopic holmium laser lithotripsy. This study is to retrospectively analyze the period from March 2015 to December 2016. The clinical efficacy and safety of holmium laser lithotripsy with flexible ureteroscope in the treatment of renal calculi in our hospital were evaluated by statistical analysis of the success rate of single endoscopic lithotripsy, stone finding rate, total stone clearance rate, operative time, intraoperative bleeding volume, postoperative hospital stay and complications. Methods From March 2015 to February 2016, 48 patients with renal calculi underwent flexible ureteroscopic holmium laser lithotripsy in the First Affiliated Hospital of Medical College of Zhejiang University were analyzed retrospectively. Among them, 29 were males and 19 were females. The age ranged from 22 to 65 years, with an average age of 44.9 (+ 8.51) years and a course of 2 to 40 days, with an average duration of 14.35 (+ 6.72) days. Among them, 35 cases were diagnosed with low back or abdominal pain, 6 cases with visible hematuria, and 7 cases without obvious symptoms were diagnosed with renal calculi by physical examination. Fifteen upper calyx stones, 21 middle calyx stones, and 12 lower calyx stones were located. The longest diameter of the stones was 2.1 cm-5.5 cm, with an average diameter of 2.82 (+ 0.96 cm). Five of the patients did not undergo extracorporeal shock wave lithotripsy and 43 had undergone extracorporeal shock wave lithotripsy. Can disease, such as diabetes, chronic nephritis, hypertension and other patients; urinary tract infection, serious hydronephrosis, urethral stricture and staghorn calculi patients and other serious systemic disease patients. Use ureteroscopic holmium laser lithotripsy ureteroscopic lithotripsy, 3 days after surgery to determine the effect of lithotripsy KUB and double J-tube location, 1 month after discharge to determine KUB. The operation time, stone removal rate and bleeding volume during operation were recorded. The hospitalization days, indwelling catheter time and complications were counted after operation. The lithotripsy was judged according to KUB or plain CT results 2 days and 1 month after operation. The success rate of single endoscopy, stone finding rate, total stone clearance rate, operation time, intraoperative bleeding volume, postoperative hospital stay and complications were analyzed. Results 1. The results showed that the average operation time of patients with upper calyceal calculi and calyceal calculi in different stone positions were different. There was no significant difference (P 0.05), but the operation time of inferior calyx stone patients was significantly longer than that of upper calyx and middle calyx patients, the difference was statistically significant (P 0.05). Eighteen patients (86%) had a successful single endoscopy, and nine patients (75%) had a successful single endoscopy. The success rate of single endoscopy in inferior calyx was significantly lower than that in upper calyx and middle calyx. The difference was statistically significant. There was no significant difference in the success rate of single endoscopy between upper calyx and middle calyx (P 0.05). Of the 48 patients, 41 (85%) had one stone removal, of which 14 (93%) had one stone removal from the upper calyx and 1 residue; 19 (90%) had one stone removal from the middle calyx and 2 residue from the lower calyx; 8 (67%) had one stone removal from the lower calyx and 4 residue from the middle calyx. There was no significant difference in stone clearance rate between the two groups (P There were 6 cases of low back pain (13%) and 3 cases of postoperative hematuria (6) without serious complications. Conclusion 1. Ureteroscopic holmium laser lithotripsy has a good therapeutic effect in the treatment of renal calculi, with a high stone clearance rate and a short operation time; 2. Ureteroscopic holmium laser lithotripsy has a good safety in the treatment of renal calculi, rapid recovery and no serious complications. 3. Ureteroscopic holmium laser lithotripsy has good clinical effect and safety in the treatment of renal calculi. It is a reliable method for the treatment of renal calculi.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.2
，
本文编号：2177442
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