多镜联合治疗急性复杂性尿路结石梗阻的疗效观察  

Clinical observation on multiplex-endoscopy combination therapy for acute and complicated urinary tract calculous obstruction

作　　者：袁超英[1] 黄苏溪[1] 袁杰[1] 闫东[1] 海拉提.阿不都力江 周海慧[1] 肖华平[1] 

机构地区：[1]武警新疆总队医院泌尿外科,乌鲁木齐830091

出　　处：《中华灾害救援医学》2016年第3期152-155,共4页Chinese Journal of Disaster Medicine

摘　　要：目的观察多镜联合治疗急性复杂性尿路结石梗阻的疗效。方法回顾性分析236例应用输尿管硬镜、输尿管软镜和经皮肾镜治疗急性复杂性尿路结石梗阻患者的临床资料,其中使用两种或两种以上内镜联合治疗的患者176例（多镜联合组）,采用单一内镜下治疗患者60例（单一镜组）。比较两组手术时间、住院时间、一期结石清石率、炎性反应程度、手术并发症等指标。结果 236例均成功解除梗阻,无1例改开放手术,无输尿管完全撕脱断裂、肾脏大出血等严重并发症。与单一镜组比较,多镜联合组住院时间缩短（t=1.371,P=0.046）,一期清石率升高（t=0.426,P=0.035）,需2期或3期经皮肾穿刺取石术（percutaneous nephrolithotomy,PCNL）患者（χ~2=41.183,P〈0.001）、术后中性粒细胞比率（χ~2=2.375,P=0.029）和C反应蛋白值（χ~2=107.102,P〈0.001）均降低,差异均有统计学意义。两组手术时间、输血情况、发热情况比较,差异均无统计学意义。结论多镜联合下治疗急性复杂性尿路结石梗阻具有净石率高、住院时间短、一期解除梗阻率高,术后炎性反应低等优点,同时安全、微创,值得临床推广应用。Objective To observe the efficacy of multiplex-endoscopy combination therapy for acute and complicated urinary tract calculous obstruction. Methods Clinical data of 236 patients with acute and complicated urinary tract calculous obstruction treated with ureteroscopy, flexible ureteroscope and percutaneous nephrolithotomy were analyzed retrospectively. 176 patients were treated with two or more than two endoscopy（multiplex-endoscopy group）, and 60 patients with a single endoscopy（single endoscopy group）. Then operation time, hospitalization length, stone free rate, degree of inflammatory reaction, and surgical complications were compared between the two groups. Results All obstructions of 236 patients were successfully removed; none of them changed to open surgery; no ureteral avulsion fracture, kidney hemorrhage and other serious complication happened. Compared with single endoscopy group, hospitalization length was shorter（t=1.371,P=0.046）, stone free rate was higher（t=0.426,P=0.035）, number of patients who need percutaneous nephrolithotomy twice or more was larger（χ~2=41.183,P〈0.001）, postoperative neutrophils ratio（χ~2=2.375,P=0.029） and c-reactive protein values（χ~2=107.102,P〈0.001） were reduced in multiplex-endoscopy group, and differences were statistically significant. Difference between two groups in operation time, blood transfusion and fever had no statistical significance. Conclusions Multiplex-endoscopy combination therapy for acute and complicated urinary tract calculous obstruction show advantages in stone free rate, hospitalization length, and first phase of relieve obstruction rate, also it is safe, minimally invasive and worthy of clinical popularization and application.

关 键 词：输尿管硬镜 输尿管软镜 经皮肾镜 复杂性尿路结石 

分 类 号：R692[医药卫生—泌尿科学]