输尿管软镜碎石术与经皮肾镜碎石术治疗输尿管上段结石的效果比较
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摘要
目的探讨输尿管软镜碎石术与经皮肾镜碎石术治疗输尿管上段结石的效果。方法将2017年1月至2018年1月本院收治的92例输尿管上段结石患者作为研究对象,按照入院顺序将其分为对照组与试验组,每组46例。对照组采用经皮肾镜碎石术治疗,试验组采用输尿管软镜碎石术治疗,比较两组手术指标、疼痛程度、结石清除率、手术创伤指标及并发症发生情况。结果试验组手术时间及住院时间均明显短于对照组,术中出血量显著少于对照组,差异具统计学意义(P<0.05)。试验组术后4、12、24、48 h VAS评分均显著低于对照组,差异具有统计学意义(P<0.05)。两组患者术后1、4周结石清除率比较,差异无统计学意义(P>0.05)。治疗后,试验组C反应蛋白水平及白细胞计数均低于对照组,差异具统计学意义(P<0.05)。试验组并发症总发生率低于对照组,差异具有统计学意义(P<0.05)。结论在输尿管上段结石治疗中,输尿管软镜碎石术与经皮肾镜碎石术均具有一定的治疗效果,且均具有较高的结石清除率,但前者手术创伤指标、疼痛评分、手术指标及并发症总发生率均显著优于后者,值得临床推广应用。
Objective To analyze the effect of flexible ureteroscopic lithotripsy and percutaneous nephrolithotripsy in the treatment of upper ureteral calculi. Methods Ninety-two patients with upper ureteral calculi admitted in our hospital from January 2017 to January 2018 were divided into control group and experimental group according to the order of admission,with 46 cases in each group. The control group was treated with percutaneous nephrolithotomy, while the experimental group was treated with flexible ureteroscope lithotripsy. The operation index, pain degree, stone clearance rate, surgical trauma index and complications between the two groups were compared. Results The operation time and hospitalization time of the experimental group were significantly shorter than those of the control group, and the intraoperative bleeding volume was significantly less than that of the control group, the differences were statistically significant(P<0.05). The VAS scores of the experimental group at 4, 12, 24, 48 hours after operation were significantly lower than those of the control group, the differences were statistically significant(P<0.05). There were no significant differences in stone clearance rates between the two groups at 1 and 4 weeks after operation(P>0.05). After treatment, the level of C reactive protein and white blood cell in the experimental group were lower than those in the control group, and the differences were statistically significant(P <0.05). The total incidence of complications in the experimental group was lower than that in the control group, and the difference was statistically significant(P<0.05). Conclusion In the treatment of upper ureteral calculi, both flexible ureteroscopic lithotripsy and percutaneous nephrolithotripsy have certain therapeutic effects and high stone clearance rate. However, the ureteroscopic lithotripsy has better trauma index, pain score, operative index and total incidence of complications than the percutaneous nephrolithotomy, which is worthy of clinical application and promotion.
Objective To analyze the effect of flexible ureteroscopic lithotripsy and percutaneous nephrolithotripsy in the treatment of upper ureteral calculi. Methods Ninety-two patients with upper ureteral calculi admitted in our hospital from January 2017 to January 2018 were divided into control group and experimental group according to the order of admission,with 46 cases in each group. The control group was treated with percutaneous nephrolithotomy, while the experimental group was treated with flexible ureteroscope lithotripsy. The operation index, pain degree, stone clearance rate, surgical trauma index and complications between the two groups were compared. Results The operation time and hospitalization time of the experimental group were significantly shorter than those of the control group, and the intraoperative bleeding volume was significantly less than that of the control group, the differences were statistically significant(P<0.05). The VAS scores of the experimental group at 4, 12, 24, 48 hours after operation were significantly lower than those of the control group, the differences were statistically significant(P<0.05). There were no significant differences in stone clearance rates between the two groups at 1 and 4 weeks after operation(P>0.05). After treatment, the level of C reactive protein and white blood cell in the experimental group were lower than those in the control group, and the differences were statistically significant(P <0.05). The total incidence of complications in the experimental group was lower than that in the control group, and the difference was statistically significant(P<0.05). Conclusion In the treatment of upper ureteral calculi, both flexible ureteroscopic lithotripsy and percutaneous nephrolithotripsy have certain therapeutic effects and high stone clearance rate. However, the ureteroscopic lithotripsy has better trauma index, pain score, operative index and total incidence of complications than the percutaneous nephrolithotomy, which is worthy of clinical application and promotion.
引文
[1]虞学助,张守浩,黄奕良,等.探讨输尿管软镜与微通道经皮肾镜钬激光碎石术在治疗输尿管上段结石中的临床效果[J].浙江创伤外科,2018,23(4):683-684.
[2]李晟,冯庆兴,刘旭东,等.经皮肾镜与经尿道输尿管软镜下钬激光碎石术治疗输尿管上段嵌顿性结石[J].局解手术学杂志,2018,27(7):504-507.
[3]徐磊,车宪平,古军.经皮肾镜碎石术联合输尿管软镜治疗老年输尿管上段嵌顿性结石疗效观察[J].新乡医学院学报,2018,35(7):597-600.
[4]YOUMING XU,WANG S,JIANHUA YU,et al.Combination therapy of ureteroscopic lithotripsy and percutaneous nephrolithotripsy for complex upper urinary tract calculi[J].Med J Chin People's Armed Police Forces,2012,23(7):557-559.
[5]郝宗耀,曾国华,刘明,等.输尿管软镜与微通道经皮肾镜碎石术治疗输尿管上段结石的对照分析[J].外科研究与新技术,2017,6(4):246-249,267.
[6]吴铁球,汪志民.输尿管硬镜联合软镜碎石术与微创经皮肾镜取石术处理输尿管上段嵌顿结石的比较[J].中国微创外科杂志,2017,17(11):970-973.
[7]杨凯钧.输尿管软镜碎石术与微创经皮肾镜碎石术治疗输尿管上段结石的疗效对比研究[J].哈尔滨医药,2016,36(4):421-422.
[8]鲁鹏,刘胜,刘美平,等.微通道经皮肾镜与输尿管软镜治疗输尿管上段结石的疗效对照分析[J].中国实用医药,2017,12(8):53-55.
[9]杨文增,崔振宇,安丰,等.输尿管软镜与微通道经皮肾镜在输尿管上段结石治疗中的对比研究[J].中国内镜杂志,2016,22(11):11-14.
[10]崔增林.输尿管软镜碎石术与微通道经皮肾镜碎石术治疗输尿管上段结石临床对比研究[J].河南医学研究,2016,25(9):1597-1598.
[11]万磊,乐有为,莫卒,等.微创经皮肾镜碎石术联合输尿管软镜治疗嵌顿性输尿管上段结石的疗效分析[J].临床医学工程,2017,24(9):1201-1202.
[12]谭小宇,陈瑶,唐园,等.输尿管软镜碎石术与经皮肾镜碎石术治疗输尿管上段结石的疗效比较[J].微创泌尿外科杂志,2016,5(3):154-157.
[13]楼正达.输尿管软镜与经皮肾镜取石术治疗输尿管上段结石的对比研究[J].浙江创伤外科,2016,21(2):249-251.
[14]赵树田,屈平保,钱海宁,等.微创经皮肾镜碎石术联合输尿管软镜治疗青年嵌顿性输尿管上段结石效果观察[J].山东医药,2016,56(10):80-81.
[15]段瑞华,梅力,张毅.输尿管软镜钬激光碎石术与经皮肾镜钬激光碎石术治疗输尿管上段结石的疗效比较[J].临床合理用药杂志,2016,9(4):32-34.
[16]赵亚伟,宗实,侯毅,等.软性输尿管镜和经皮肾镜治疗输尿管上段结石的对比分析[J].微创泌尿外科杂志,2015,4(6):344-347.
[17]ALENEZI H,DENSTEDT JD.Flexible ureteroscopy:technological advancements,current indications and outcomes in the treatment of urolithiasis[J].Asian J of Urol,2015,2(3):133-141.
[2]李晟,冯庆兴,刘旭东,等.经皮肾镜与经尿道输尿管软镜下钬激光碎石术治疗输尿管上段嵌顿性结石[J].局解手术学杂志,2018,27(7):504-507.
[3]徐磊,车宪平,古军.经皮肾镜碎石术联合输尿管软镜治疗老年输尿管上段嵌顿性结石疗效观察[J].新乡医学院学报,2018,35(7):597-600.
[4]YOUMING XU,WANG S,JIANHUA YU,et al.Combination therapy of ureteroscopic lithotripsy and percutaneous nephrolithotripsy for complex upper urinary tract calculi[J].Med J Chin People's Armed Police Forces,2012,23(7):557-559.
[5]郝宗耀,曾国华,刘明,等.输尿管软镜与微通道经皮肾镜碎石术治疗输尿管上段结石的对照分析[J].外科研究与新技术,2017,6(4):246-249,267.
[6]吴铁球,汪志民.输尿管硬镜联合软镜碎石术与微创经皮肾镜取石术处理输尿管上段嵌顿结石的比较[J].中国微创外科杂志,2017,17(11):970-973.
[7]杨凯钧.输尿管软镜碎石术与微创经皮肾镜碎石术治疗输尿管上段结石的疗效对比研究[J].哈尔滨医药,2016,36(4):421-422.
[8]鲁鹏,刘胜,刘美平,等.微通道经皮肾镜与输尿管软镜治疗输尿管上段结石的疗效对照分析[J].中国实用医药,2017,12(8):53-55.
[9]杨文增,崔振宇,安丰,等.输尿管软镜与微通道经皮肾镜在输尿管上段结石治疗中的对比研究[J].中国内镜杂志,2016,22(11):11-14.
[10]崔增林.输尿管软镜碎石术与微通道经皮肾镜碎石术治疗输尿管上段结石临床对比研究[J].河南医学研究,2016,25(9):1597-1598.
[11]万磊,乐有为,莫卒,等.微创经皮肾镜碎石术联合输尿管软镜治疗嵌顿性输尿管上段结石的疗效分析[J].临床医学工程,2017,24(9):1201-1202.
[12]谭小宇,陈瑶,唐园,等.输尿管软镜碎石术与经皮肾镜碎石术治疗输尿管上段结石的疗效比较[J].微创泌尿外科杂志,2016,5(3):154-157.
[13]楼正达.输尿管软镜与经皮肾镜取石术治疗输尿管上段结石的对比研究[J].浙江创伤外科,2016,21(2):249-251.
[14]赵树田,屈平保,钱海宁,等.微创经皮肾镜碎石术联合输尿管软镜治疗青年嵌顿性输尿管上段结石效果观察[J].山东医药,2016,56(10):80-81.
[15]段瑞华,梅力,张毅.输尿管软镜钬激光碎石术与经皮肾镜钬激光碎石术治疗输尿管上段结石的疗效比较[J].临床合理用药杂志,2016,9(4):32-34.
[16]赵亚伟,宗实,侯毅,等.软性输尿管镜和经皮肾镜治疗输尿管上段结石的对比分析[J].微创泌尿外科杂志,2015,4(6):344-347.
[17]ALENEZI H,DENSTEDT JD.Flexible ureteroscopy:technological advancements,current indications and outcomes in the treatment of urolithiasis[J].Asian J of Urol,2015,2(3):133-141.