斜侧卧位+低压灌注+半截双“J”管拦堵在输尿管镜碎石术治疗输尿管中上段结石中的应用
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摘要
目的:探讨应用斜侧卧位+低压灌注+半截双"J"管拦堵在输尿管镜碎石术治疗输尿管中上段结石中的临床效果及安全性。方法:回顾性分析本院2016年1月-2017年9月收治并行输尿管镜碎石术的输尿管中上段结石患者120例的临床资料,根据患者选取的手术方式不同将其分为A组(n=27)、B组(n=30)、C组(n=34)和D组(n=29)。A组使用低压灌注+斜侧卧位,B组使用低压灌注+斜侧卧位+半截双"J"管拦堵,C组使用低压灌注+截石位+半截双"J"管拦堵,D组使用低压灌注+截石位。观察四组手术和住院时间、住院医疗费用、术后结石上移、术后1个月结石排净和手术成功率,以及术后并发症发生情况。结果:四组手术和住院时间、住院医疗费用比较,差异均无统计学意义(P>0.05)。A、B、C组术后结石上移率均明显低于D组,手术成功及术后1个月结石排净率均明显高于D组,差异均有统计学意义(P<0.05)。其中,B组术后结石上移率均明显低于A、C组,手术成功及术后1个月结石排净率均明显优于A、C组,差异均有统计学意义(P<0.05)。B组术后并发症发生率均明显低于A、C、D组,差异均有统计学意义(X~2=8.500,P<0.05)。结论:斜侧卧位+低压灌注+半截双"J"管拦堵在输尿管镜碎石术治疗输尿管中上段结石方面疗效均优于其他术式,且术后并发症少,值得临床推广。
Objective:To investigate the clinical effect and safety of oblique lateral position+low pressure perfusion+half double "J" tube blockage in the treatment of upper and middle ureteral calculi by ureteroscopic lithotripsy.Method:The clinical data of 120 patients with upper and middle ureteral calculi treated by ureteroscopic lithotripsy from January 2016 to September 2017 were retrospectively analyzed.According to the patient's choice of operation,they were divided into group A(n=27),group B(n=30),group C(n=34)and group D(n=29).Group A was given low pressure perfusion+oblique lateral position,group B was given low pressure perfusion+oblique lateral position+half double "J" tube blockage, group C was given low pressure infusion+lithotomy position+half double "J" tube blockage and group D was given low-pressure perfusion+lithotomy position.The operation and hospitalization time,hospitalization cost,the rate of upward movement of postoperative stone,the rate of stone removal after operation 1 month,the success rate of operation and postoperative complications were observed among the four groups.Result:There were no significant differences in operation and hospitalization time and hospitalization cost among the four groups(P>0.05).The rate of upward movement of postoperative stones in group A,B and C were significantly lower than that in group D,the success rate of operation and the rate of stone removal after operation 1 month were significantly higher than those in group D,the differences were statistically significant(P<0.05).The rate of upward movement of postoperative stones in group B was significantly lower than those in group A and C,the success rate of operation and the rate of stone removal after operation 1 month was significantly higher than those in group A and C,the differences were statistically significant(P<0.05).The incidence of postoperative complications in group B was significantly lower than those in group A,C and D,the differences were statistically significant( x~2=8.500,P<0.05).Conclusion:Oblique lateral position+low pressure perfusion+half double "J" tube blockage by ureteroscopic lithotripsy in the treatment of upper and middle ureteral calculi is superior to other surgical procedures, and less postoperative complications,which is worthy of clinical promotion.
Objective:To investigate the clinical effect and safety of oblique lateral position+low pressure perfusion+half double "J" tube blockage in the treatment of upper and middle ureteral calculi by ureteroscopic lithotripsy.Method:The clinical data of 120 patients with upper and middle ureteral calculi treated by ureteroscopic lithotripsy from January 2016 to September 2017 were retrospectively analyzed.According to the patient's choice of operation,they were divided into group A(n=27),group B(n=30),group C(n=34)and group D(n=29).Group A was given low pressure perfusion+oblique lateral position,group B was given low pressure perfusion+oblique lateral position+half double "J" tube blockage, group C was given low pressure infusion+lithotomy position+half double "J" tube blockage and group D was given low-pressure perfusion+lithotomy position.The operation and hospitalization time,hospitalization cost,the rate of upward movement of postoperative stone,the rate of stone removal after operation 1 month,the success rate of operation and postoperative complications were observed among the four groups.Result:There were no significant differences in operation and hospitalization time and hospitalization cost among the four groups(P>0.05).The rate of upward movement of postoperative stones in group A,B and C were significantly lower than that in group D,the success rate of operation and the rate of stone removal after operation 1 month were significantly higher than those in group D,the differences were statistically significant(P<0.05).The rate of upward movement of postoperative stones in group B was significantly lower than those in group A and C,the success rate of operation and the rate of stone removal after operation 1 month was significantly higher than those in group A and C,the differences were statistically significant(P<0.05).The incidence of postoperative complications in group B was significantly lower than those in group A,C and D,the differences were statistically significant( x~2=8.500,P<0.05).Conclusion:Oblique lateral position+low pressure perfusion+half double "J" tube blockage by ureteroscopic lithotripsy in the treatment of upper and middle ureteral calculi is superior to other surgical procedures, and less postoperative complications,which is worthy of clinical promotion.
引文
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[2]Dretler S P.Ureteroscopy for proximal ureteral calculi:prevention of stone migration[J].J Endourol,2000,14(7):565-567.
[3]Eisner B H,Feldman A S,Chapin B F,et al.“Blind coning”-using the stone conefor removal of intramural ureteral calculi[J].Urology,2007,69(4):773-775.
[4]陈兴发.泌尿系结石诊疗指南解读[J].现代泌尿外科杂志,2010,15(6):408-410.
[5]黄占洪,李文科,刘跃光,等.拦截网篮和无封堵装置在治疗输尿管上段结石手术中的对比分析[J].中国综合临床,2016,32(11):993-996.
[6]闫辉.低压灌注加导管引流在逆行输尿管镜碎石中的应用[J].淮海医药,2014,32(5):479-480.
[7]任晓磊.NTrap网篮在输尿管镜钬激光碎石术治疗输尿管上段结石中的应用研究[D].武汉:华中科技大学,2012.
[8]谭光忠,陈文锴,杨波,等.利尿剂配合输尿管镜气压弹道碎石术治疗输尿管结石临床分析[J].重庆医学,2010,35(3):55-56.
[9]吴贵贤,崔茂荣,张小德,等.提高肾盂压力在输尿管镜碎石术治疗输尿管结石中的应用(附80例报告)[J].国际泌尿系统杂志,2011,31(4):467-469.
[10]Lee H,Ryan R T,Teichman J M,et al.Stoneretropulsion during holmium:YAG lithotripsy[J].J Urol,2003,169:881-885.
[11]曹敬毅,戚景光,管同郁,等.输尿管镜气压弹道碎石术中防止结石上移的方法比较[J].现代泌尿外科杂志,2008,13(3):222-223.
[12]Haupt G,Pannek J,Herde T,et al.The Lithovac:new suction device for the Swiss Lithoclast[J].J Endourol,1995,9(5):375-377.
[13]哈木拉提·吐送,艾沙江·阿不力,安尼瓦尔·牙生,等.输尿管镜气压弹道联合真空负压吸附碎石清石术治疗输尿管结石237例临床分析[J].新疆医科大学学报,2012,35(11):1519-1522.
[14]洪景范,杨增士,叶宁.侧卧位输尿管镜碎石术治疗输尿管上段结石68例报告[J].中华泌尿外科杂志,2006,27(2):143.
[15]杨增士,洪景范,叶宁,等.侧卧位输尿管镜钬激光碎石术治疗输尿管上段结石疗效观察[J].中华实用诊断与治疗杂志,2011,25(9):917-918.
[16]梁阳冰.斜仰卧位联合截石位同时输尿管镜下结合经皮肾镜取石术治疗上下尿路结石的疗效观察[J].中国实用医药,2013,8(31):93-94.
[17]罗红,余丽华,杨慧.改良侧卧位在经输尿管镜碎石手术中的应用[J].护理研究,2010,24(6):502-503.
[18]姜红光.斜仰卧-截石位经输尿管硬镜钬激光碎石取石术治疗输尿管上段结石284例[J].中国实用医药,2014,9(7):127.
[19]罗怀景,余丰.低压灌注在输尿管镜治疗输尿管结石合并急性肾感染的应用[J].河南外科学杂志,2013,19(2):25-26.
[20]邢发枢,张涛,郑哲明.低压灌注输尿管镜碎石术治疗输尿管上段结石的临床应用[J].中国医学创新,2010,7(20):180-181.
[2]Dretler S P.Ureteroscopy for proximal ureteral calculi:prevention of stone migration[J].J Endourol,2000,14(7):565-567.
[3]Eisner B H,Feldman A S,Chapin B F,et al.“Blind coning”-using the stone conefor removal of intramural ureteral calculi[J].Urology,2007,69(4):773-775.
[4]陈兴发.泌尿系结石诊疗指南解读[J].现代泌尿外科杂志,2010,15(6):408-410.
[5]黄占洪,李文科,刘跃光,等.拦截网篮和无封堵装置在治疗输尿管上段结石手术中的对比分析[J].中国综合临床,2016,32(11):993-996.
[6]闫辉.低压灌注加导管引流在逆行输尿管镜碎石中的应用[J].淮海医药,2014,32(5):479-480.
[7]任晓磊.NTrap网篮在输尿管镜钬激光碎石术治疗输尿管上段结石中的应用研究[D].武汉:华中科技大学,2012.
[8]谭光忠,陈文锴,杨波,等.利尿剂配合输尿管镜气压弹道碎石术治疗输尿管结石临床分析[J].重庆医学,2010,35(3):55-56.
[9]吴贵贤,崔茂荣,张小德,等.提高肾盂压力在输尿管镜碎石术治疗输尿管结石中的应用(附80例报告)[J].国际泌尿系统杂志,2011,31(4):467-469.
[10]Lee H,Ryan R T,Teichman J M,et al.Stoneretropulsion during holmium:YAG lithotripsy[J].J Urol,2003,169:881-885.
[11]曹敬毅,戚景光,管同郁,等.输尿管镜气压弹道碎石术中防止结石上移的方法比较[J].现代泌尿外科杂志,2008,13(3):222-223.
[12]Haupt G,Pannek J,Herde T,et al.The Lithovac:new suction device for the Swiss Lithoclast[J].J Endourol,1995,9(5):375-377.
[13]哈木拉提·吐送,艾沙江·阿不力,安尼瓦尔·牙生,等.输尿管镜气压弹道联合真空负压吸附碎石清石术治疗输尿管结石237例临床分析[J].新疆医科大学学报,2012,35(11):1519-1522.
[14]洪景范,杨增士,叶宁.侧卧位输尿管镜碎石术治疗输尿管上段结石68例报告[J].中华泌尿外科杂志,2006,27(2):143.
[15]杨增士,洪景范,叶宁,等.侧卧位输尿管镜钬激光碎石术治疗输尿管上段结石疗效观察[J].中华实用诊断与治疗杂志,2011,25(9):917-918.
[16]梁阳冰.斜仰卧位联合截石位同时输尿管镜下结合经皮肾镜取石术治疗上下尿路结石的疗效观察[J].中国实用医药,2013,8(31):93-94.
[17]罗红,余丽华,杨慧.改良侧卧位在经输尿管镜碎石手术中的应用[J].护理研究,2010,24(6):502-503.
[18]姜红光.斜仰卧-截石位经输尿管硬镜钬激光碎石取石术治疗输尿管上段结石284例[J].中国实用医药,2014,9(7):127.
[19]罗怀景,余丰.低压灌注在输尿管镜治疗输尿管结石合并急性肾感染的应用[J].河南外科学杂志,2013,19(2):25-26.
[20]邢发枢,张涛,郑哲明.低压灌注输尿管镜碎石术治疗输尿管上段结石的临床应用[J].中国医学创新,2010,7(20):180-181.