球囊扩张、开放手术与腹腔镜手术治疗输尿管狭窄的疗效比较

发布时间：2019-06-04 00:25

【摘要】：目的:通过对球囊扩张、开放手术与腹腔镜手术三种不同术式治疗输尿管狭窄的效果进行比较,了解上述不同手术方式的优缺点及预后,指导以后的治疗。方法:本文选取了吉林大学第一医院泌尿外一科自2011年1月至2015年12月治疗的输尿管狭窄患者,排除了完全闭塞,外部压迫和恶性肿瘤导致的输尿管狭窄,确定了其中138例狭窄段长度小于2cm的良性输尿管狭窄的患者作为我们的研究对象。将138例患者分为A、B、C三组。A组采用经尿道逆行球囊扩张术治疗,共25例。B组采用腹腔镜手术治疗,共21例。C组采用开放手术治疗,共92例。比较A、B、C三组患者的手术时间、术中出血量、术后进食时间、术后住院时间、围手术期并发症及术后有效率等。术后有效率为治愈的患者加好转患者所占该组患者数的百分比。本组研究分为术后6个月有效率和术后1年有效率,即拔出双J管后随访6个月和1年所得出的有效率的值,其中6个月有效率称为短期有效率,1年有效率称为长期有效率。使用Spss软件进行分析,计数资料比较采用X2检验,计量资料比较采用LSD-T检验。P0.05被认为具有统计学意义。结果:138个患者失访9个,其中球囊扩张组失访两个,腹腔镜组失访一个,开放手术组失访6个。三组患者手术时间、术中出血量、术后进食时间、术后住院天数通过LSD-T检验两两比较可得,A组在上述四个方面比B组和C组优势明显(P0.001),B组在术中出血量、术后进食时间、术后住院天数方面比C组更具优势(P0.05),C组在手术时间方面比B组有优势(P0.001)。三组患者在围手术期并发症的比较差异无统计学意义(P=0.451)。术后6个月有效率之间的比较,三组之间差异不显著(P=0.836);术1年有效率之间的比较,三组之间差异显著(P=0.016),再运用Spss软件进行两两之间的比较,其中B组和C组的1年有效率相当(P=0.754),上述两组和A组之间1年有效率的比较有统计学意义(P0.05)。结论:1、对于狭窄段小于2cm的非压迫性良性输尿管狭窄,经尿道逆行球囊扩张术在手术时间、术中出血量、术后进食时间、术后住院时间等方面较腹腔镜组及开放手术组具有明显的优势,同时具有不亚于上述两组的短期有效率;而在长期有效率方面,腹腔镜组和开放手术组更具有优势;2、腹腔镜组和开放手术组在短期和长期有效率方面没有明显的差异性,腹腔镜组在术中出血量、术后进食时间、术后住院天数方面比开放手术组具有明显的优势;3、结合患者狭窄段的长度,肾脏功能,一般身体状态,再选择不同的手术方式。
[Abstract]:Objective: to compare the effects of balloon dilatation, open operation and laparoscopic surgery in the treatment of ureter stricture, and to understand the advantages, disadvantages and prognosis of the above different surgical methods, and to guide the treatment in the future. Methods: the patients with ureter stricture treated from January 2011 to December 2015 were selected from the Department of Urology, the first Hospital of Jilin University, and the ureter stricture caused by complete occlusion, external compression and malignant tumor was excluded. Among them, 138 patients with benign ureter stricture whose length of stricture segment was less than 2cm were identified as the subjects of our study. 138 patients were divided into three groups: group A (n = 25), group B (n = 21) and group C (n = 92). Group A was treated with retrograde balloon dilatation of urethra. Group B was treated with laparoscopic surgery (n = 21). Group C was treated with open surgery (n = 92). The operation time, intraoperative blood loss, postoperative eating time, postoperative hospitalization time, perioperative complications and postoperative effective rate of group A, B and C were compared. The postoperative effective rate was the percentage of cured and improved patients in this group. The study was divided into 6 months effective rate and 1 year effective rate after operation, that is, the effective rate obtained after 6 months and 1 year follow-up after pulling out the double J tube, in which the 6 month effective rate was called short term effective rate and the 1 year effective rate was long term effective rate. Spss software was used for analysis, X2 test was used to compare the counting data, and LSD-T test was used to compare the measurement data. P05 was considered to have statistical significance. Results: nine of 138 patients were lost, including 2 in balloon dilatation group, 1 in laparoscopy group and 6 in open operation group. The operation time, intraoperative blood loss, postoperative eating time and postoperative hospitalization days of the three groups were compared by LSD-T test. Group A was superior to group B and group C in the above four aspects (P0.001group). The postoperative eating time and postoperative hospitalization days were more superior than those in group C (P 0.05), C group was superior to group B in operation time) (P0.001). There was no significant difference in perioperative complications among the three groups (P 鈮，

本文编号：2492339