输尿管镜下钬激光碎石与气压弹道碎石术治疗输尿管结石临床对比研究

发布时间：2018-11-17 15:10

【摘要】：目的:随着生活水平的提高以及饮食习惯的改变,泌尿系结石发病率越来越高,其中以输尿管结石最为常见。输尿管结石的治疗方法包括保守治疗、体外冲击波碎石、输尿管镜下碎石取石术、经皮肾镜碎石取石术、腹腔镜下输尿管切开取石术以及传统的开放手术。目前输尿管镜下碎石取石术常见方法包括钬激光碎石术和气压弹道碎石术。由于两组碎石方式的原理不同,故在治疗输尿管结石的疗效及安全性方面可能存在差异。本研究对比观察这两种手术方式的相关临床数据,运用统计学方法比较这两种术式在治疗输尿管结石方面的疗效及安全性,同时探讨输尿管镜下钬激光碎石术的临床经验,为临床实践提供参考资料。方法:比较我院2014年9月至2016年9月经输尿管镜下钬激光碎石术治疗246例和气压弹道碎石术治疗215例输尿管结石患者的临床资料。根据碎石成功率、术中结石逃逸率、合并症(息肉、狭窄)的处理、手术时间、住院时间以及中、术后并发症(术中输尿管穿孔、尿外渗、术中输尿管黏膜撕脱、术中输尿管断裂、术后发热、术后血尿)的发生、结石清除率等方面的数据,进行统计学分析,比较两种术式各自的优缺点。结果:对于输尿管上段结石,HL组的碎石成功率、结石清除率、术中结石逃逸率分别是88.37%、83.72%、11.63%,优于PL组的67.57%、62.16%、32.43%,差异有统计学意义(P0.05);对于输尿管中段结石,HL组的碎石成功率、结石清除率、术中结石逃逸率分别是92.96%、88.73%、7.04%,PL组分别是89.83%、83.05%、10.17%;输尿管下段结石,HL组的碎石成功率、结石清除率、术中结石逃逸率分别是97.73%、94.70%、2.27%,PL组分别是97.48%、91.60%、2.52%,对于中、下段结石,两组上述方面差异无统计学意义。HL组的手术时间、住院时间、术后血尿时间分别是39.0286±13.0561min、6.2857±1.9034d、1.7290±0.8888d,明显短于PL组的47.9742±18.1749min、6.7804±2.3384d、2.0327±0.7005d,差异有统计学意义(P0.5)。两组均未发生严重的术中、术后并发症,但钬激光具有对合并的息肉或狭窄予以烧灼或切开后再处理结石的优点。结论:输尿管镜下钬激光碎石和气压弹道碎石术在治疗输尿管结石方面均具有安全、有效、创伤小、恢复快、术中术后并发症少等特点。对于输尿管上段结石,钬激光组具有较高的碎石成功率、结石清除率以及较低的术中结石逃逸率;同时钬激光组的术后血尿、手术时间、住院时间等方面优于气压弹道组,且钬激光可以术中一并处理合并的输尿管息肉、狭窄。输尿管镜下钬激光碎石术尤其适用于上段输尿管结石,特别是合并息肉、狭窄的输尿管结石患者,是治疗输尿管结石理想的手术方式。
[Abstract]:Objective: with the improvement of living standard and the change of dietary habits, the incidence of urinary calculi is increasing, among which ureteral calculi are the most common. The treatment of ureteral calculi includes conservative treatment, extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy, percutaneous nephrolithotripsy, laparoscopic ureterotomy and traditional open surgery. The common methods of ureteroscopic lithotripsy include holmium laser lithotripsy and pneumatic lithotripsy. There may be differences in the efficacy and safety of the two groups in the treatment of ureteral calculi due to different principles of lithotripsy. In this study, we compared the clinical data of the two surgical procedures, compared the efficacy and safety of the two methods in the treatment of ureteral calculi, and discussed the clinical experience of ureteroscopic holmium laser lithotripsy. To provide reference for clinical practice. Methods: the clinical data of 246 patients treated with holmium laser lithotripsy under ureteroscope and 215 patients with ureteral calculi treated by pneumatic lithotripsy from September 2014 to September 2016 were compared. According to the success rate of lithotripsy, the rate of stone escape during operation, the management of complications (polyp, stenosis), operation time, hospital stay and complications (ureteral perforation, urinary exosmosis, intraoperative ureteral mucosal avulsion, intraoperative ureteral perforation, ureteral mucosal avulsion. The data of ureteral rupture, postoperative fever, postoperative hematuria and stone clearance were analyzed statistically, and the advantages and disadvantages of the two methods were compared. Results: for upper ureteral calculi, the success rate of lithotripsy, the rate of stone clearance and the escape rate of stones in HL group were 88.370.83.72and 11.63respectively, which were better than 67.57 and 32.43in PL group. The difference was statistically significant (P0.05). For the middle ureteral calculi, the lithotripsy success rate, the stone clearance rate and the intraoperative stone escape rate in the HL group were 92.96 and 88.73, respectively. In the PL group, they were 89.83% and 83.05% and 10.17%, respectively. In HL group, the lithotripsy success rate, stone clearance rate and stone escape rate in HL group were 97.73 and 94.70 respectively, and 97.4848 and 91.60 in PL group were 91.60 and 2.52, respectively, and 97.4848 and 91.60 in the middle and lower segment of ureteral calculi, and 91.60 in the middle and lower segment of ureteral calculi, respectively. The operation time, hospitalization time and postoperative hematuria time in HL group were 39.0286 卤13.0561min and 6.2857 卤1.9034d, 1.7290 卤0.8888 days, respectively, which were significantly shorter than those in PL group (47.9742 卤18.1749min, 6.7804 卤2.33384d). The difference was statistically significant (2.0327 卤0.7005 d). There were no serious intraoperative and postoperative complications in both groups, but holmium laser had the advantage of cauterizing or cutting stones after resection or resection of the associated polyps or stenosis. Conclusion: ureteroscopic holmium laser lithotripsy and pneumatic lithotripsy are safe, effective, less invasive, quick recovery and less postoperative complications in the treatment of ureteral calculi. For upper ureteral calculi, holmium laser group had higher lithotripsy success rate, lower stone removal rate and lower escape rate during operation. At the same time, the hematuria, operation time and hospital stay in holmium laser group were better than those in pneumatic ballistic group, and holmium laser could be used to treat ureteral polyps and stricture. Ureteroscopic holmium laser lithotripsy is especially suitable for upper ureteral calculi, especially for ureteral calculi with polyps and narrow ureteral calculi.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.4

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