不同术式治疗膀胱结石的临床疗效及术后发热的影响因素分析  

Clinical effect of different surgical methods and the influencing factors of postoperative fever in the treatment of cystolith

作　　者：武立伟[1] 曹雷涛 王娜[2] 陈平莲[3] 赵永辉[3] 孟伟红 

机构地区：[1]定州市人民医院泌尿血管外科,河北定州073000 [2]定州市人民医院超声科,河北定州073000 [3]定州市人民医院病理科,河北定州073000

出　　处：《中国临床研究》2018年第1期73-76,共4页Chinese Journal of Clinical Research

基　　金：河北省卫计委课题(20171496)

摘　　要：目的对三种不同的手术方式治疗膀胱结石的临床效果及手术过程中所有可能引发术后发热的因素进行分析,以期为临床医师具体手术方式的选择及膀胱结石术后发热的预防提供参考。方法对2014年1月至2017年1月收治的膀胱结石120例患者的临床资料进行回顾性分析。以采用电切镜联合输尿管镜下气压弹道碎石术治疗者为I组、肾镜下气压弹道碎石术治疗者为Ⅱ组,肾镜下EMS五代超声碎石清石系统手术治疗者为Ⅲ组,每组各40例。记录每例手术碎石时间、术中出血量、手术并发症和住院时间、术后发热情况等并进行统计分析。结果在碎石时间、术中出血量、住院时间三个方面,Ⅲ组优于Ⅰ组和Ⅱ组(P均<0.05);但Ⅱ组与Ⅰ比较差异均无统计学意义(P均>0.05)。Ⅲ组术后感染、血尿、尿潴留及发热等并发症发生率略低于Ⅰ组和Ⅱ组,但三组比较差异无统计学意义(P均>0.05)。将三组120例患者按有无术后发热分为有术后发热组21例,无术后发热组99例;对术后发热的影响因素进行分析,结果显示,有术后发热组术中出血量显著高于无术后发热组[(22.5±3.2)ml vs(18.4±3.1)ml,P<0.05];碎石时间和术后感染、血尿、尿潴留发生率在术后有无发热者中的差异均无统计学意义(P均>0.05)。结论肾镜下EMS五代超声碎石清石系统手术的疗效更好,碎石时间短,术中出血量少且住院时间短。初步分析发现术后发热与术中出血量可能有相关性。Objective To analyze the clinical effects of three different surgical methods in the treatment of cystolith and explore the possible factors that may lead to postoperative fever in order to provide a reference for clinicians to choose the specific surgical methods and prevent postoperative fever. Methods The clinical data of 120 cystolith patients between January 2014 and January 2017 were retrospectively analyzed in the study. All patients were grouped according to the method of operation by retrospective analysis ：pneumatic ballistic lithotripsy via resectoscope and ureteroscope （group Ⅰ ）, pneumatic ballistic lithotripsy via nephroscope （group Ⅱ ） and the fifth generation EMS ultrasound lithotripsy system via nephroscope （group m, n = 40 each ）. The lithotripsy time, intraoperative blood loss, complications, hospital stay and postoperative fever were recorded and analyzed. Results The lithotripsy time,intraoperative blood loss and hospital stay in group m were significantly lower than those in group Ⅰ and group Ⅱ （ all P 〈 0.05 ）, but there was no significant difference in lithotripsy time,intraoperative blood loss and hospital stay between group Ⅲ and group Ⅰ （ all P 〉 0.05）. The incidences of postoperative infection, hematuria, urinary retention and fever in group m was slightly lower than those of group I and group Ⅱ , but the differenee was not statistically significant （ all P 〉 0.05 ）. The 120 patients were divided into postoperative fever group （ n = 21 ） and non-postoperative fever group （ n = 99 ）. The influencing factors of postoperative fever were analyzed. The results showed that the intraoperative blood loss in postoperative fever group was significantly higher than that in non-postoperative fever group [ （ 22.5± 3.2 ） ml vs （ 18.4± 3. 1 ） ml, P 〈 0.05 ]. There was no significant difference in the incidence of postoperative infection, hematuria and urinary retention in the patients with or without fever （ all P 〉 0.05 ）. Concl

关 键 词：膀胱结石 电切镜联合输尿管镜下气压弹道碎石术 肾镜下 气压弹道碎石术 EMS五代超声碎石清石系统 术后发热 

分 类 号：R694.4[医药卫生—泌尿科学]