两种术式治疗肾盂输尿管连接部梗阻的疗效对比

发布时间：2018-08-12 07:31

【摘要】：目的:探讨与对比开放和后腹腔镜下离断性肾盂成形术治疗肾盂输尿管连接处梗阻的疗效。方法:选择回顾分析2009年4月~2013年3月期间我院收治的肾盂输尿管连接部梗阻患者120例,分为治疗组与对照组各60例,对照组给予开放离断肾盂成形术,治疗组给予后腹腔镜离断肾盂成形术,观察两组的围手术指标与术后并发症的发生情况,观察两组患者手术前后的肾积水及肾功能情况,同时术后进行随访调查6个月,对复发情况进行观察。全部统计分析使用SPSS 13.00软件,设定P0.05提示差异有统计学意义。结果:所有患者手术均取得成功,统计治疗组的手术时间、手术中的出血量、术后肠道排气时间、术后止痛药使用时间、术后住院时间都明显少于对照组,对比差异经t检验都有统计学意义(P0.05)。治疗组术后切口感染、尿漏(漏尿时间超过两周)、恶心呕吐、切口出血、肺部感染等并发症发生情况明显少于对照组,组间经检验对比差异有统计学意义(P0.05);所有并发症经过对症处理后好转,未影响到术后随访。两组术前肾积水状况对比差异无统计学意义,术后肾积水程度都明显好转(P0.05),同时术后治疗组的肾积水程度明显好于对照组(P0.05)。所有患者术后随访6个月,经过观察,治疗组的梗阻再发、肾积水加重、肾功能损害肾切除情况都明显低于对照组(P0.05)。结论:后腹腔镜离断性肾盂成形术治疗肾盂输尿管连接部梗阻与传统开放离断性肾盂成形术相比,手术成功率都比较高,但是后腹腔镜手术创伤更小,术后恢复更快,能减少并发症的发生,促进肾功能的恢复,患者较易接受,随访复发率也比较少,可逐渐替代传统开放手术治疗,作为治疗肾盂输尿管连接部梗阻的新的“金标准”。
[Abstract]:Objective: to investigate and compare the efficacy of open and retroperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction. Methods: 120 patients with ureteropelvic junction obstruction treated in our hospital from April 2009 to March 2013 were retrospectively analyzed and divided into treatment group (n = 60) and control group (n = 60). The patients in the treatment group were treated with retroperitoneal laparoscopic pyeloplasty. The perioperative indexes and postoperative complications were observed. The hydronephrosis and renal function were observed before and after operation. The recurrence was observed. All the statistical analysis using SPSS 13.00 software, set P0.05 hint difference was statistically significant. Results: all the patients were successfully operated. The time of operation, the amount of bleeding during operation, the time of intestinal exhaust, the time of postoperative analgesic use, the time of hospitalization after operation in the treatment group were significantly less than those in the control group. The difference was statistically significant by t test (P0.05). In the treatment group, the incidence of incision infection, urine leakage (more than two weeks), nausea and vomiting, incision bleeding, pulmonary infection and other complications were significantly less than those in the control group. The difference between the two groups was statistically significant (P0.05); all the complications were improved after symptomatic treatment and did not affect the postoperative follow-up. There was no significant difference between the two groups in the status of hydronephrosis before operation. The degree of hydronephrosis was significantly improved after operation (P0.05), and the degree of hydronephrosis in the treatment group was significantly better than that in the control group (P0.05). All the patients were followed up for 6 months. After observation, the cases of obstruction, hydronephrosis and nephrectomy in the treatment group were significantly lower than those in the control group (P0.05). Conclusion: compared with traditional open pyeloplasty, the successful rate of retroperitoneal laparoscopic dissecting pyeloplasty for the treatment of ureteropelvic junction obstruction is higher than that of traditional open pyeloplasty, but the wound is less and the postoperative recovery is faster. It can reduce the incidence of complications and promote the recovery of renal function. The patients are easy to accept and the recurrence rate of follow-up is relatively small. It can gradually replace the traditional open surgical treatment as a new "golden standard" for the treatment of ureteropelvic junction obstruction.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R699

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