国际医药卫生导报
國際醫藥衛生導報
국제의약위생도보
INTERNATIONAL MEDICINE & HEALTH GUIDANCE NEWS
2015年
11期
1520-1525
,共6页
郭巍巍%闫润林%王力%张江涛%刘春
郭巍巍%閆潤林%王力%張江濤%劉春
곽외외%염윤림%왕력%장강도%류춘
经皮肾镜%输尿管软镜%肾结石%钬激光
經皮腎鏡%輸尿管軟鏡%腎結石%鈥激光
경피신경%수뇨관연경%신결석%화격광
Percutaneous nephrolithotripsy%Flexible ureteroscope%Renal calculi%Holmium laser
目的 比较经皮肾镜碎石取石术和输尿管软镜钬激光碎石术治疗1～2cm肾结石,探讨1～ 2cm肾结石的适宜治疗方案.方法 选取2014年3月至2015年3月山西省长治市人民医院泌尿外科收治的单侧肾结石47例,结石直径1～ 2cm,将其随机分为经皮肾镜碎石术组24例和输尿管软镜钬激光碎石术组23例,分别行手术治疗,比较两种术式患者的年龄、性别、结石数目、结石大小、手术时间、术后无石率、术中出血量、术后高热发生率,术后疼痛、住院天数和手术费用.结果 两组年龄、性别、结石数目及结石大小差异无统计学意义(P＞0.05),具有可比性.经皮肾镜碎石取石术组手术时间(57.9±13.4) min,输尿管软镜钬激光碎石术组(54.3±12.9) min,差异无统计学意义(P＞0.05).经皮肾镜碎石取石术组有2例有残留结石,清除率为91.7％,输尿管软镜钬激光碎石术组有3例有残留结石,清除率为86.9％,差异无统计学意义(P＞0.05).输尿管软镜钬激光碎石术组术中出血(44.6±15.3) ml,经皮肾镜碎石取石术组出血量(76.1±17.2)ml,差异有统计学意义(P＜0.05).输尿管软镜钬激光碎石术组术后高热发生率13.0％ (3/23),经皮肾镜碎石取石术组术后高热发生率16.7％(4/24),差异无统计学意义(P＞0.05).经皮肾镜碎石取石术组术后镇痛发生率20.8％ (5/24),输尿管软镜钬激光碎石术组术后未使用镇痛药物,差异有统计学意义(P＜0.05).输尿管软镜钬激光碎石术组术后住院天数(5.2±1.5)天,经皮肾镜碎石取石术组(8.4±1.6)天,差异有统计学意义(P＜0.05).输尿管软镜钬激光碎石术组手术费用(1.5±0.2)万元,经皮肾镜碎石取石术组(1.1±0.1)万元,差异有统计学意义(P＜0.05).结论 输尿管软镜钬激光碎石术比经皮肾镜碎石取石术有术中出血少、术后疼痛少、术后住院时间短、并发症少的优势,而在无石率、手术时间方面差异无统计学意义,对于1～2 cm的肾结石的手术治疗,首选输尿管软镜钬激光碎石术.
目的 比較經皮腎鏡碎石取石術和輸尿管軟鏡鈥激光碎石術治療1～2cm腎結石,探討1～ 2cm腎結石的適宜治療方案.方法 選取2014年3月至2015年3月山西省長治市人民醫院泌尿外科收治的單側腎結石47例,結石直徑1～ 2cm,將其隨機分為經皮腎鏡碎石術組24例和輸尿管軟鏡鈥激光碎石術組23例,分彆行手術治療,比較兩種術式患者的年齡、性彆、結石數目、結石大小、手術時間、術後無石率、術中齣血量、術後高熱髮生率,術後疼痛、住院天數和手術費用.結果 兩組年齡、性彆、結石數目及結石大小差異無統計學意義(P＞0.05),具有可比性.經皮腎鏡碎石取石術組手術時間(57.9±13.4) min,輸尿管軟鏡鈥激光碎石術組(54.3±12.9) min,差異無統計學意義(P＞0.05).經皮腎鏡碎石取石術組有2例有殘留結石,清除率為91.7％,輸尿管軟鏡鈥激光碎石術組有3例有殘留結石,清除率為86.9％,差異無統計學意義(P＞0.05).輸尿管軟鏡鈥激光碎石術組術中齣血(44.6±15.3) ml,經皮腎鏡碎石取石術組齣血量(76.1±17.2)ml,差異有統計學意義(P＜0.05).輸尿管軟鏡鈥激光碎石術組術後高熱髮生率13.0％ (3/23),經皮腎鏡碎石取石術組術後高熱髮生率16.7％(4/24),差異無統計學意義(P＞0.05).經皮腎鏡碎石取石術組術後鎮痛髮生率20.8％ (5/24),輸尿管軟鏡鈥激光碎石術組術後未使用鎮痛藥物,差異有統計學意義(P＜0.05).輸尿管軟鏡鈥激光碎石術組術後住院天數(5.2±1.5)天,經皮腎鏡碎石取石術組(8.4±1.6)天,差異有統計學意義(P＜0.05).輸尿管軟鏡鈥激光碎石術組手術費用(1.5±0.2)萬元,經皮腎鏡碎石取石術組(1.1±0.1)萬元,差異有統計學意義(P＜0.05).結論 輸尿管軟鏡鈥激光碎石術比經皮腎鏡碎石取石術有術中齣血少、術後疼痛少、術後住院時間短、併髮癥少的優勢,而在無石率、手術時間方麵差異無統計學意義,對于1～2 cm的腎結石的手術治療,首選輸尿管軟鏡鈥激光碎石術.
목적 비교경피신경쇄석취석술화수뇨관연경화격광쇄석술치료1～2cm신결석,탐토1～ 2cm신결석적괄의치료방안.방법 선취2014년3월지2015년3월산서성장치시인민의원비뇨외과수치적단측신결석47례,결석직경1～ 2cm,장기수궤분위경피신경쇄석술조24례화수뇨관연경화격광쇄석술조23례,분별행수술치료,비교량충술식환자적년령、성별、결석수목、결석대소、수술시간、술후무석솔、술중출혈량、술후고열발생솔,술후동통、주원천수화수술비용.결과 량조년령、성별、결석수목급결석대소차이무통계학의의(P＞0.05),구유가비성.경피신경쇄석취석술조수술시간(57.9±13.4) min,수뇨관연경화격광쇄석술조(54.3±12.9) min,차이무통계학의의(P＞0.05).경피신경쇄석취석술조유2례유잔류결석,청제솔위91.7％,수뇨관연경화격광쇄석술조유3례유잔류결석,청제솔위86.9％,차이무통계학의의(P＞0.05).수뇨관연경화격광쇄석술조술중출혈(44.6±15.3) ml,경피신경쇄석취석술조출혈량(76.1±17.2)ml,차이유통계학의의(P＜0.05).수뇨관연경화격광쇄석술조술후고열발생솔13.0％ (3/23),경피신경쇄석취석술조술후고열발생솔16.7％(4/24),차이무통계학의의(P＞0.05).경피신경쇄석취석술조술후진통발생솔20.8％ (5/24),수뇨관연경화격광쇄석술조술후미사용진통약물,차이유통계학의의(P＜0.05).수뇨관연경화격광쇄석술조술후주원천수(5.2±1.5)천,경피신경쇄석취석술조(8.4±1.6)천,차이유통계학의의(P＜0.05).수뇨관연경화격광쇄석술조수술비용(1.5±0.2)만원,경피신경쇄석취석술조(1.1±0.1)만원,차이유통계학의의(P＜0.05).결론 수뇨관연경화격광쇄석술비경피신경쇄석취석술유술중출혈소、술후동통소、술후주원시간단、병발증소적우세,이재무석솔、수술시간방면차이무통계학의의,대우1～2 cm적신결석적수술치료,수선수뇨관연경화격광쇄석술.
Objective To explore an appropriate treatment method for renal calculi comparing percutaneous nephrolithotomy and flexible ureteroscope holmium laser lithotripsy for 1-2 cm renal calculi.Methods 47 patients with unilateral renal calculi admitted into Changzhi People's Hospital from Match,2014 to Match,2015 were chosen.The diameter of the stones ranged from 1 to 2 cm.The patients were randomly divided into a percutaneous nephrolithotomy group (n=24) and a flexible ureteroscope holmium laser lithotripsy group (n=23).The patient's age,sex,number of calculi,calculi size,operation time,calculi-free rate after surgery,bleeding volume,incidence of postoperative fever,postoperative pain,length of hospital stay,and surgical expenses were compared between these two groups.Results There were no statistical differences in age,gender,number of calculi,and calculi size between theses two groups (P ＞0.05).The operation time was(57.9±13.4) min in the percutaneous nephrolithotomy group and was (54.3±12.9) min in the flexible ureteroscope holmium laser lithotripsy group,with no statistical difference(P ＜0.05).2 cases were not calculi-free in the percutaneous nephrolithotomy group,with a clearance rate of 91.7％,and 3 in the flexible ureteroscope holmium laser lithotripsy group,with a clearance rate of 86.9％,with no statistical difference(P ＞0.05).The bleeding volume was (76.1±17.2) ml in the percutaneous nephrolithotomy group and was (44.6±15.3) ml in the flexible ureteroscope holmium laser lithotripsy group,with a statistical difference (P ＜0.05).The incidence of postoperative fever was 16.7％(4/24) in the percutaneous nephrolithotomy group and was 13.0％(3/23) in the flexible ureteroscope holmium laser lithotripsy group,with no statistical difference(P ＞0.05).5 got postoperative pain in the percutaneous nephrolithotomy group and none in the flexible ureteroscope holmium laser lithotripsy group,with a statistical difference(P ＜0.05).The length of hospital stay was (8.4±1.6) days in the percutaneous nephrolithotomy group and was (5.2±1.5) days in the flexible ureteroscope holmium laser lithotripsy group,with a statistical difference(P ＞0.05).The surgery cost was (11±1) thousand yuan in the percutaneous nephrolithotomy group and was (15±2) in the flexible ureteroscope holmium laser lithotripsy group,with a statistical difference(P ＜0.05).Conclusions The bleeding volume is smaller,the length of hospital stay shorter,and the incidences of postoperative pain and complications lower in percutaneous nephrolithotomy than in flexible ureteroscope holmium laser lithotripsy.There are no statistical differences in calculi-free rate and operation time between these two operations.Flexible ureteroscope holmium laser lithotripsy is the first choice for 1-2 cm renal calculi.
