输尿管镜下钬激光碎石术治疗输尿管中、下段结石的效果
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摘要
目的探究输尿管镜下钬激光碎石术治疗输尿管结石的临床效果。方法选取2013年1月~2017年1月我院收治的110例输尿管中、下段结石患者作为研究对象,随机分为对照组(n=54)与观察组(n=56),分别接受输尿管镜下气压弹道碎石术与输尿管镜下钬激光碎石术。比较两组患者输尿管结石的清除效果、围术期指标及安全性。结果观察组结石清除率为89.3%,与对照组结石清除率(94.4%)比较,差异无统计学意义(P>0.05);术后1年观察组的结石复发率为5.4%,对照组结石复发率为1.9%,两组比较,差异无统计学意义(P>0.05);观察组的手术时间、住院时间及胃肠功能恢复时间均明显短于对照组,术中出血量少于对照组,术后镇痛药物使用率明显低于对照组,差异有统计学意义(P<0.05);两组患者的并发症发生率比较,差异无统计学意义(P>0.05)。结论输尿管镜下钬激光碎石术治疗输尿管中、下段结石效果优于输尿管镜下气压弹道碎石术,术后损伤小、恢复快,值得临床推广运用。
Objective To explore the clinical effect of ureteroscopic holmium laser lithotripsy and laparoscopic ureterolithotomy in the treatment of ureteral calculi.Methods A total of 110 patients with middle and lower ureteral calculi treated from January 2013 to January 2017 were randomly divided into the control group(n=54) and the observation group(n=56).The ureteroscopic pneumatic lithotripsy and the ureteroscopic holmium laser lithotripsy were performed respectively.The clearance effect,perioperative indicators and safety of two groups were compared.Results The stone clearance rate in the observation group was 89.3%,the control group was 94.4%,the difference was not statistically significant(P>0.05).In 1 years after operation,the recurrence rate of stones in observation group was 5.4%,while in control group,stone recurrence rate was 1.9%,there was no significant difference between two groups(P>0.05).The operation time,the time of hospitalization and the recovery time of gastrointestinal function in the observation group were significantly shorter than those in the control group,the amount of bleeding in the operation was significantly less than that in the control group,and the postoperative analgesic drug use rate was significantly lower than that in the control group,the difference was statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion The effect of ureteroscopic holmium laser lithotripsy in the treatment of middle and lower ureteral calculi is better than that of ureteroscopic pneumatic lithotripsy.The postoperative injury is small,the recovery is fast.It is worthy of clinical application.
Objective To explore the clinical effect of ureteroscopic holmium laser lithotripsy and laparoscopic ureterolithotomy in the treatment of ureteral calculi.Methods A total of 110 patients with middle and lower ureteral calculi treated from January 2013 to January 2017 were randomly divided into the control group(n=54) and the observation group(n=56).The ureteroscopic pneumatic lithotripsy and the ureteroscopic holmium laser lithotripsy were performed respectively.The clearance effect,perioperative indicators and safety of two groups were compared.Results The stone clearance rate in the observation group was 89.3%,the control group was 94.4%,the difference was not statistically significant(P>0.05).In 1 years after operation,the recurrence rate of stones in observation group was 5.4%,while in control group,stone recurrence rate was 1.9%,there was no significant difference between two groups(P>0.05).The operation time,the time of hospitalization and the recovery time of gastrointestinal function in the observation group were significantly shorter than those in the control group,the amount of bleeding in the operation was significantly less than that in the control group,and the postoperative analgesic drug use rate was significantly lower than that in the control group,the difference was statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion The effect of ureteroscopic holmium laser lithotripsy in the treatment of middle and lower ureteral calculi is better than that of ureteroscopic pneumatic lithotripsy.The postoperative injury is small,the recovery is fast.It is worthy of clinical application.
引文
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[11]刘定益,王健,张翀宇,等.输尿管镜钬激光治疗输尿管结石合并息肉[J].中国微创外科杂志,2011,11(8):741-742.
[12]吴忠,丁强,姜昊文,等.输尿管肾镜钬激光碎石术治疗输尿管结石[J].中国激光医学杂志,2010,26(6):27-29.
[13]张立冬,李辉,唐为民,等.经输尿管镜钬激光碎石术治疗输尿管结石232例[J].重庆医学,2012,41(1):80-81.
[14]李辉,王伟高,谢波.输尿管镜钬激光碎石术对输尿管结石术患者发生感染的可行性及安全性研究[J].中华医院感染学杂志,2015(8):1857-1859.
[15]郭小林,宋晓东,陈志强,等.经输尿管镜钬激光碎石治疗ESWL失败的输尿管结石[J].中国内镜杂志,2004,10(1):23-25.
[2]顾方六.尿石症的流行病学和病因学[J].中华泌尿外科杂志,2003,24(10):717-719.
[3]吴序立,吴琳珊,郑培奎,等.基层医院输尿管镜钬激光碎石术治疗输尿管结石的综合疗效分析[J].中华腔镜泌尿外科杂志(电子版),2014,8(3):43-46.
[4]刘定益,俞家顺,王健,等.输尿管镜钬激光治疗输尿管结石1015例疗效分析[J].中国微创外科杂志,2015(8):695-698.
[5]杨乐,杨妍欣.微创手术治疗前列腺增生合并输尿管结石的临床治疗效果分析[J].吉林医学,2013,34(18):3570-3570.
[6]那彦群.中国泌尿外科疾病诊断治疗指南[M].人民卫生出版社,2013:129-130.
[7]潘铁军.泌尿系结石微创手术治疗进展[J].中国当代医药,2013,20(6):18-20.
[8]张立进,吴斌,查振雷,等.后腹腔镜下输尿管切开取石术与输尿管软镜钬激光碎石术治疗复杂性上段输尿管结石的效果分析[J].中华外科杂志,2017,55(10):751-754.
[9]李南南,汪志民,唐智旺,等.后腹腔镜下输尿管切开取石术87例报告[J].中国微创外科杂志,2014(10):933-934.
[10]吴序立,吴琳珊,郑培奎,等.基层医院输尿管镜钬激光碎石术治疗输尿管结石的综合疗效分析[J].中华腔镜泌尿外科杂志(电子版),2014,8(3):43-46.
[11]刘定益,王健,张翀宇,等.输尿管镜钬激光治疗输尿管结石合并息肉[J].中国微创外科杂志,2011,11(8):741-742.
[12]吴忠,丁强,姜昊文,等.输尿管肾镜钬激光碎石术治疗输尿管结石[J].中国激光医学杂志,2010,26(6):27-29.
[13]张立冬,李辉,唐为民,等.经输尿管镜钬激光碎石术治疗输尿管结石232例[J].重庆医学,2012,41(1):80-81.
[14]李辉,王伟高,谢波.输尿管镜钬激光碎石术对输尿管结石术患者发生感染的可行性及安全性研究[J].中华医院感染学杂志,2015(8):1857-1859.
[15]郭小林,宋晓东,陈志强,等.经输尿管镜钬激光碎石治疗ESWL失败的输尿管结石[J].中国内镜杂志,2004,10(1):23-25.