微创经皮肾镜与输尿管软镜下钬激光碎石治疗输尿管上段结石的疗效比较

发布时间：2019-05-10 13:02

【摘要】：目的:对比微创经皮肾镜(MPCNL)与输尿管软镜下钬激光碎石(FURS)治疗输尿管上段结石的临床疗效。方法:我院2015年6月至2016年1月收治的明确诊断输尿管上段结石患者40例,输尿管上段单发结石,结石直径在0.7-1.0cm之间行ESWL治疗失败的患者及结石直径在1.0-3.0cm之间的患者。根据手术方式的不同将患者分为两组:MPCNL组24例,FURS组16例。对比两组患者的年龄、结石大小、积水程度、手术时间、术后住院天数、结石残留率、术后并发症、术后镇痛剂使用等指标。结果:经皮肾镜组平均手术时间77.63±13.90min,输尿管软镜组平均手术时间75.94±28.71min,两组差异无统计学意义(P0.05)。经皮肾镜组术后住院时间8.83±3.02天,输尿管软镜组术后住院时间4.38±1.09天,两组间差异对比有统计学意义(P0.01)。两组患者手术均成功,未有因穿刺失败或输尿管软镜无法置入而导致术式改变的情况发生。经皮肾镜组术后结石残留率8.3%(2/24),输尿管软镜组术后结石残留率18.8%(3/16)。经皮肾镜组术后使用镇痛剂4例;术后并发出血2例,1例经保守治疗后痊愈,1例行DSA+栓塞治疗后痊愈,术后发热1例。输尿管软镜组术后均未使用镇痛剂,术中术后无明显并发症发生。结论:输尿管软镜钬激光碎石术治疗位于肾盂输尿管连接部与肾下极水平之间、直径在0.7-1.0cm之间行ESWL治疗失败的及直径在1.0-3.0cm的输尿管上段单发结石,较微创经皮肾镜钬激光碎石术手术操作简单、创伤小、痛苦轻、术后并发症少,但术前需增加一次住院以留置输尿管双J管,增加患者的时间与经济负担,以及留置双J管带来的并发症的风险。临床上选择手术方式时也受到患者肾积水程度的影响,在微创经皮肾镜组患者的肾积水程度较输尿管软镜组重,其差异有统计学意义。我们认为,在临床上应根据患者的实际情况选择手术方式。
[Abstract]:Objective: to compare the clinical efficacy of minimally invasive (MPCNL) and holmium laser lithotripsy (FURS) in the treatment of upper ureter calculi. Methods: from June 2015 to January 2016, 40 patients with upper ureter calculi were diagnosed as single stones in the upper ureter. Patients with stone diameter between 0.7-1.0cm and patients with failed ESWL treatment and patients with stone diameter between 1.0-3.0cm. According to the different surgical methods, the patients were divided into two groups: MPCNL group (n = 24) and FURS group (n = 16). The age, size of stone, degree of hydronephrosis, operation time, days of hospitalization, residual rate of stone, postoperative complications and the use of postoperative analgesic agents were compared between the two groups. Results: the average operation time was 77.63 卤13.90 min in the percutaneous renoscopy group and 75.94 卤28.71 min in the ureter soft mirror group. There was no significant difference between the two groups (P 0.05). The postoperative hospital stay was 8.83 卤3.02 days in the percutaneous renoscopy group and 4.38 卤1.09 days in the ureter soft mirror group. There was significant difference between the two groups (P 0.01). The operation was successful in both groups, and there was no change of operation caused by the failure of puncture or the inability of ureter soft lens to be inserted. The residual rate was 8.3% (2 / 24) in the percutaneous nephroscopy group and 18.8% (3 / 16) in the soft ureteroscopy group. In the percutaneous renoscopy group, 4 cases were treated with painkillers, 2 cases were complicated with bleeding, 1 case was cured after conservative treatment, 1 case was cured after DSA embolism, and 1 case was febrile after operation. In the soft ureter group, no painkillers were used after operation, and no obvious complications occurred during and after operation. Conclusion: Ureteroscopic holmium laser lithotripsy is located between the junction of the ureter and the inferior pole of the kidney, the diameter of which is between the 0.7-1.0cm and the upper segment of the ureter with the failure of ESWL and the single stone of the upper ureter with the diameter of 1.0-3.0cm. Compared with minimally invasive percutaneous holmium laser lithotripsy, the operation is simple, less trauma, less pain and less postoperative complications, but it is necessary to increase the hospitalization before operation to retain the double J tube of ureter, so as to increase the time and economic burden of the patients. And the risk of complications caused by indwelling double J tube. The degree of hydronephrosis in the minimally invasive percutaneous nephroscopy group was more severe than that in the soft ureteroscopy group, and the difference was significant (P < 0.05). The degree of hydronephrosis was also influenced by the degree of hydronephrosis in the patients with minimally invasive percutaneous nephroscopy. We believe that the surgical method should be selected according to the actual situation of the patients.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R699.4

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