必须声明标量变量 "@Script_ID"。 软性输尿管镜碎石术治疗上尿路结石180例报告-《赣南医学院学报》

[1]廖文成,李优苼,祝家兴,等.软性输尿管镜碎石术治疗上尿路结石180例报告[J].赣南医学院学报,2019,39(10):1014-1017.[doi:10.3969/j.issn.1001-5779.2019.10.010]
 LIAO Wen-cheng,LI You-sheng,ZHU Jia-xing,et al.Retrograde lntrarenal Surgery for Upper Urinary Stones: a report of 180 cases[J].,2019,39(10):1014-1017.[doi:10.3969/j.issn.1001-5779.2019.10.010]
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软性输尿管镜碎石术治疗上尿路结石180例报告()
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《赣南医学院学报》[ISSN:1001-5779/CN:36-1154/R]

卷:
39
期数:
2019年10期
页码:
1014-1017
栏目:
临床研究
出版日期:
2019-11-24

文章信息/Info

Title:
Retrograde lntrarenal Surgery for Upper Urinary Stones: a report of 180 cases
文章编号:
1001-5779(2019)10-1014-04
作者:
廖文成1李优苼1祝家兴1林 峰1徐开鑫1吴检发1张国玺2
1.赣州市赣县区人民医院泌尿外科; 2.赣南医学院第一附属医院,江西 赣州 341000
Author(s):
LIAO Wen-cheng1 LI You-sheng1 ZHU Jia-xing1 LIN Feng1 XU Kai-xin1 WU Jian-fa1 ZHANG Guo-xi2
1.Department of Urology, People's Hospital of Ganxian; 2.The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi 341000
关键词:
上尿路结石 软性输尿管镜
Keywords:
Upper Urinary Stones flexible ureterscope
分类号:
R691.4
DOI:
10.3969/j.issn.1001-5779.2019.10.010
文献标志码:
A
摘要:
目的:探讨输尿管软镜碎石术治疗上尿路结石的安全性及有效性。方法:回顾性分析2016年7月-2018年7月我院收治的180例上尿路结石患者的临床资料。其中输尿管上段结石39例,肾结石133例,肾结石合并输尿管结石8例。单发结石126例,多发54例,双侧结石12例,直径8~24 mm,平均18 mm。160例术前合并泌尿系感染,均给予敏感抗生素抗感染治疗。所有患者于全麻或腰硬联合麻醉下取截石位,采用输尿管软镜钬激光碎石术,术后评估手术时间、术后住院时间、术后并发症及结石清除率。结果:180例中170例一期顺利完成手术; 4例因置入外鞘失败留置双J管2周后二期完成手术; 6例因输尿管狭窄改行经皮肾镜取石术。170例完成输尿管软镜碎石术的患者,手术时间30~140 min,平均59.8 min; 结石清除率为94.7%(161/170)。术前白细胞、红细胞、血肌酐分别为(7.36±2.25)×109·L-1、(4.16±0.38)×1012·L-1、(83.2±3.85)μmol·L-1,术后白细胞、红细胞、血肌酐分别为(7.25±2.13)×109·L-1、(4.18±0.52)×1012·L-1、(84.5±3.32)μmol·L-1,手术前后比较差异均无统计学意义(P>0.05)。术后发热发生率为7.6%(13/170),尿源性脓毒血症发生率为 0.58%(1/170),因灌注液体外渗致腰痛发生率为1.17%(2/170),肾周血肿发生率为1.17%(2/170),无大出血、输尿管穿孔、石街等并发症,无死亡病例。术后住院时间平均2.7 d。结论:输尿管软镜碎石术治疗上尿路结石安全、有效,值得临床推广应用。
Abstract:
Objective: To evaluate the efficacy and safety of flexible ureteroscopy in the treament of intrarenal and proximal ureteral stones.Methods: Form July 2016 to July 2018,a total of 180 patients, There were 39 cases of ureteral calculi, 133 cases of renal calculiand 8 cases of renal calculi combined with ureteral calcul.There were 126 cases of single calculi and 54 eases of multiple calculi.The average size of stone was 8-24 mm, mean 18mm.There were 160 cases of urinary tract infection who were treated by the sensitive antibiotic.All patients underwent lithotomy under general anesthesia or combined spinal epidural anesthesia, used Holmium laser lithotripsy with flexible ureteroscope.Statistical analysis was performed regarding operative time, postoperative hospital stay, stone-free rates, and complications.Results: One hundred and seventy of 180 patients only accepted one surgery to remove the stone.Four cases failed the firstsurgery due to difficulty in placing the ureteral accesssheath but flexible ureteroscopy were successfully performed in these patients after indwelling a D-J stent for 2 weeks.Six cases were converted to percutaneous nephrolithotomy due to ureteral stricture.The average operative time was 30-140 min(mean 59.8min)and the stone-free rates was 94.7%(161/170).The levels of serum creatinine, leukocyte and erythrocyte of the postoperatively patients were(7.36±2.25)×109·L-1、(4.16±0.38)×1012·L-1、(83.2±3.85)μmol·L-1, respectively.The levels of serum creatinine, leukocyte and erythrocyte of the postoperatively patients were(7.25±2.13)×109·L-1、(4.18±0.52)×1012·L-1、(84.5±3.32)μmol·L-1, respectively.There was no statistically significant difference betweenpreoperative and postoperative(P>0.05).The incidence of postoperative fever was 7.6%(13/170), the incidence of urinary sepsis was 0.58%(1/170), the incidence of lumbago caused by extravasation was 1.17%(2/170), the incidence ofperirenal hematoma was 1.17%(2/170), and no peripheral viscera injury or death case.Average postoperative hospital stay was 2.7 d.Conclusions: Flexible ureteroscopic lithotripsy for upper urinary calculi is safe and effective.It is worthy of clinical application.

参考文献/References:

[1] Giusti G, Proietti S, Villa L, et al.Current Standard Technique for Modern Flexible Ureteroscopy: Tips and Tricks[J].Eur Urol, 2016, 70(1): 188-194.
[2] Jiang H, Yu Z, Chen L, et al.Minimally Invasive Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery for Upper Urinary Stones: A Systematic Review and Meta-Analysis[J].Biomed Res Int, 2017, 2017(3): 2035851.
[3] 刘荣福, 何弘毅, 王雪刚, 等.术前留置双J管对输尿管软镜碎石术疗效影响的Meta分析[J].中华泌尿外科杂志, 2018, 39(6): 455-460.
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[5] 刘海超, 许长宝, 赵兴华, 等.注射器注水法输尿管软镜术中肾盂压力测定的安全性评价[J].中华泌尿外科杂志, 2016, 37(2): 135-138.
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备注/Memo

备注/Memo:
基金项目:赣州市指导性科技计划项目(编号:GZ2017ZSF387)
作者简介:廖文成,男,本科,主治医师,研究方向:泌尿外科。E-mail:liaowc886@126.com
更新日期/Last Update: 2019-11-20