无管化与传统经皮肾镜的对比研究

发布时间：2019-07-01 20:36

【摘要】：背景和目的经皮肾镜技术经过半个多世纪的发展，在和传统开放手术的竞争中，逐渐体现出独特的优势，并成为了复杂性肾结石的首选治疗方法。随着科技的进步，操作水平的提高，近年来不少科学家们逐渐意识到传统经皮肾镜术后留置肾造瘘管给患者带来的痛苦和诸多不便，进而试图淘汰这种落后的引流方式，并为此做了不少实验研究工作；但同样也有不少学者不赞成这种观点，认为术后不放置肾造瘘管会引起严重并发症，进而给患者带来更大的危害。带着以上两种观点，并总结了之前学者们的工作经验，我们开展了此次临床对比研究，目的还是为了探讨无管化经皮肾镜相对于传统经皮肾镜处理上尿路结石的有效性和安全性，及在临床工作中是否存在优势。方法回顾性分析2011年1月-2013年10月期间，105例行经皮肾镜取石术（percutaneous nephrolithotomy，PCNL）的上尿路结石患者。其中39例行无管化经皮肾镜取石术（无管化组），另外66例行传统经皮肾镜取石术（传统组）。入选病例在性别、年龄、结石参数等指标上均无明显统计学差异（P＞0.05）。对两组病例的手术时间、术后24h视觉模拟疼痛评分、镇痛药需求、感染发生情况、术后失血情况及输血率、术后肠道功能恢复时间、肾周血肿及积液情况、术后住院时间、住院费用等指标进行统计分析。结果105例手术均成功完成，无中转开放病例，无胸膜及肠管等周围脏器损伤病例发生，无感染性休克病例发生。所有患者出院后均随访一月，无严重并发症出现。无管化组与传统组在手术时间（52.92±7.95min vs55.59±7.21min P＞0.05），，发热发生率（9/39vs14/66P＞0.05），术后Hb下降值（8.00±4.03g/L vs8.62±4.33g/LP＞0.05），术后HCT下降值（4.29%±1.27%vs4.61%±1.36%P＞0.05），术后输血率（0/39vs1/66P＞0.05），术后肠道功能恢复时间（15.55±5.59h vs16.74±6.58h P＞0.05），肾周血肿发生率（2/39vs7/66P＞0.05），肾周积液发生率（10/39vs28/66P＞0.05）及清石率（33/39vs58/66P＞0.05)方面无明显统计学差异。而在术后24hVAS（2.41±1.32分vs4.54±1.65分P＜0.05），术后镇痛药的需求率（3/39vs15/66P＜0.05），术后恢复工作时间（14.97±4.73d vs20.18±5.25d P＜0.05），术后平均住院时间（5.82±1.00d vs7.76±1.45d P＜0.05），术后平均住院费用（2805.41±385.63元vs4243.86±596.52元P＜0.05）方面均存在明显统计学差异。结论无管化经皮肾镜是对传统经皮肾镜手术引流方式的改进，通过临床对比研究发现，在减少术后疼痛及镇痛药物需求，缩短住院时间、降低医疗费用等方面具有优势。在经严格筛选病例，熟练手术操作和术毕准确判断能否行无管化的基础上，无管化经皮肾镜是一种效果可靠、安全、经济的方法，值得推广应用。
[Abstract]:Background and objective after more than half a century of development, percutaneous nephroscopy has gradually shown its unique advantages in the competition with traditional open surgery, and has become the first choice for the treatment of complex kidney stones. With the progress of science and technology and the improvement of operation level, in recent years, many scientists have gradually realized the pain and inconvenience caused by indwelling renostomy tube after traditional transcatheter renal endoscopy, and then tried to eliminate this backward drainage method, and have done a lot of experimental research work for this purpose. However, many scholars do not agree with this view, that the placement of renostomy tube after operation will cause serious complications, and then bring greater harm to patients. With the above two viewpoints and summing up the previous working experience of scholars, we have carried out this clinical comparative study in order to explore the effectiveness and safety of non-tubular percutaneous nephroscopy in the treatment of upper urinary calculi compared with traditional transcatheter nephroscopy, and whether there are advantages in clinical work. Methods from January 2011 to October 2013, 105 patients with upper urinary tract stones treated with percutaneous nephrolithotomy,PCNL were analyzed retrospectively. the results were as follows: (1) from January 2011 to October 2013, 105 patients with upper urinary calculi were analyzed. Among them, 39 cases were treated with non-catheterization and 66 cases with traditional percutaneous nephrolithotomy (traditional group), while 39 cases were treated with endoscophenoscopic lithotomy (non-tubular group) and 66 cases by traditional nephrolithotomy (traditional group), and the other 66 cases were treated with traditional nephrolithotomy. There was no significant difference in sex, age and stone parameters (P > 0.05). The operation time, visual simulated pain score 24 hours after operation, analgesic demand, infection occurrence, postoperative blood loss and transfusion rate, postoperative intestinal function recovery time, perirenal hematomas and fluid accumulation, postoperative hospitalization time and hospitalization expenses were statistically analyzed. Results 105 cases of operation were successfully completed, no cases of conversion to open, no cases of pleura and intestinal tract injury, no cases of septic shock occurred. All patients were followed up for one month after discharge, and no serious complications occurred. The time of operation (52.92 卤7.95min vs55.59 卤7.21min P > 0.05), the incidence of fever (9/39vs14/66P > 0.05), the decrease of Hb (8.00 卤4.03g/L vs8.62 卤4.33g/LP > 0.05), the decrease of HCT (4.29% 卤1.27% vs 4.61% 卤1.36% P > 0.05), the postoperative transfusion rate (0/39vs1/66P > 0.05). There was no significant difference in the recovery time of intestinal function (15.55 卤5.59h vs16.74 卤6.58h P > 0.05), the incidence of perirenal hematomas (2/39vs7/66P > 0.05), the incidence of perirenal fluid accumulation (10/39vs28/66P > 0.05) and the rate of stone clearance (33/39vs58/66P > 0.05). The postoperative 24hVAS (2.41 卤1.32 vs4.54 卤1.65, P < 0.05), the demand rate of postoperative painkillers (3/39vs15/66P < 0.05), the recovery time (14.97 卤4.73 d vs20.18 卤5.25 d P < 0.05), and the average postoperative hospital stay (5.82 卤1.00 d vs7.76 卤1.45 d P < 0.05), the postoperative recovery time (14.97 卤4.73 d vs20.18 卤5.25 d P < 0.05), the average postoperative hospital stay (5.82 卤1.00 d vs7.76 卤1.45 d P < 0.05). There were significant differences in the average postoperative hospitalization expenses (2805.41 卤385.63 yuan vs4243.86 卤596.52 yuan, P < 0.05). Conclusion Catheter is an improvement of traditional endoscopic drainage. Through clinical comparative study, it is found that it has advantages in reducing postoperative pain and analgesic drug demand, shortening hospitalization time and reducing medical expenses. On the basis of strict screening of cases, skillful operation and accurate judgment of tracheization at the end of operation, tubular percutaneous nephroscopy is a reliable, safe and economical method, which is worth popularizing and applying.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2

【参考文献】