体外冲击波与输尿管镜气压弹道碎石术急诊治疗输尿管结石合并急性肾绞痛的临床对比分析

发布时间：2019-07-04 06:01

【摘要】：目的：比较体外冲击波碎石术(extracorporeal shock wave lithotripsy, ESWL)与输尿管镜下气压弹道碎石术(ureteroscopic pneumatic lithotripsy, URSL)急诊治疗输尿管结石并急性肾绞痛的疗效及并发症发生情况。方法：回顾性分析我院近2年来80例急诊ESWL(ESWL组)以及68例急诊URSL(URSL组)治疗输尿管结石并急性肾绞痛患者的临床及随访资料,比较两组患者的术后疼痛缓解率、一次性碎石成功率、术后2周结石清除率、再次治疗率、并发症发生率等指标。结果：经统计分析,URSL组患者术后疼痛缓解率(95.59%)、一次性碎石成功率(92.65%)、术后2周结石清除率(94.12%)均明显高于ESWL组(分别为76.25%、75.00%、77.50%,P0.05)、再次治疗率(10.29%)明显低于ESWL组(33.75%,P0.05)。两组输尿管结石患者术后并发症发生率比较无统计学差异(分别为27.94%、26.25%,P0.05)。根据输尿管结石位置分布及直径大小两种因素分段后分析,与ESWL组患者相比,URSL组结石位于输尿管上段及结石直径5～10mm的患者一次性碎石成功率、术后2周结石清除率以及并发症发生率无统计学差异(P0.05);URSL组结石位于输尿管中下段以及结石直径大于10mm的患者术后疼痛缓解率、一次性碎石成功率、术后2周结石清除率明显高于ESWL组(P0.05),再次治疗率明显低于ESWL组(P0.05)。结论：急诊ESWL与急诊URSL均为输尿管结石合并急性肾绞痛应用解痉镇痛药物无效患者确切有效、安全的治疗方法。对于位于输尿管上段、直径5～10mm的结石,可首选急诊ESWL；输尿管中下段、直径大于10mm的结石,首先考虑行急诊URSL具备一定的临床推广价值。
[Abstract]:Objective: to compare the efficacy and complications of extracorporeal shock wave lithotripsy (extracorporeal shock wave lithotripsy, ESWL) and pneumatic lithotripsy (ureteroscopic pneumatic lithotripsy, URSL) in the emergency treatment of ureter calculi complicated with acute renal colic. Methods: the clinical and follow-up data of 80 patients with ESWL (ESWL and 68 patients with acute renal colic in our hospital in recent 2 years were analyzed retrospectively. the postoperative pain relief rate, the success rate of disposable lithotripsy, the stone clearance rate 2 weeks after operation, the rate of retreatment and the incidence of complications were compared between the two groups. Results: after statistical analysis, the postoperative pain relief rate (95.59%), the success rate of disposable lithotripsy (92.65%) and the stone clearance rate (94.12%) in URSL group were significantly higher than those in ESWL group (76.25%, 75.00%, 77.50%, P 0.05), and the rate of retreatment (10.29%) was significantly lower than that in ESWL group (33.75%, P 0.05). There was no significant difference in the incidence of postoperative complications between the two groups (27.94%, 26.25%, P 0.05). According to the location distribution and diameter of ureter stones, compared with ESWL group, the success rate of one-off lithotripsy in URSL group was not significantly different from that in 5~10mm patients with upper ureter segment and stone diameter, and there was no significant difference in stone clearance rate and incidence of complications 2 weeks after operation (P 0.05). The pain relief rate of patients with stones located in the middle and lower ureter and patients with stone diameter larger than 10mm in URSL group were significantly higher than those in ESWL group 2 weeks after operation (P 0.05), and the rate of re-treatment was significantly lower than that in ESWL group (P 0.05). Conclusion: both emergency ESWL and emergency URSL are effective and safe methods for the treatment of ureter calculi complicated with acute renal colic with ineffective antispasmodic and analgesic drugs. For stones located in the upper segment of ureter and 5~10mm in diameter, emergency ESWL; is the first choice for middle and lower ureter, and stones larger than 10mm. First of all, emergency URSL has certain clinical value.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699

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