经皮肾镜气压弹道碎石联合输尿管镜钬激光治疗复杂性上尿路结石效果观察  

Percutaneous Nephroscopic Pneumatic Lithotripsy Combined with Ureteroscopic Holmium Laser in the Treatment of Complex Upper Urinary Calculi

作　　者：李乘龙 赵永哲 王君 赵伟 贺迎雪 方园林 刘尧 张雷 屈慧展 郎俊 LI Chenglong;ZHAO Yongzhe;WANG Jun;ZHAO Wei;HE Yingxue;FANG Yuanlin;LIU Yao;ZHANG Lei;QU Huizhan;LANG Jun(Beijing Yanqing District Hospital,Beijing 102100,China)

机构地区：[1]北京市延庆区医院

出　　处：《中外医学研究》2019年第34期11-13,共3页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:观察经皮肾镜气压弹道碎石联合输尿管镜钬激光治疗复杂性上尿路结石效果。方法:将在笔者所在医院近期(2016年9月-2018年9月)收治的以复杂性上尿路结石为诊断的100例患者采取随机数字法分为对照组(50例)与联合组(50例),其中对照组患者采取经皮肾镜气压弹道碎石治疗,联合组采取经皮肾镜气压弹道碎石联合输尿管镜钬激光治疗,并对患者进行1年的有效随访。对照两组患者围手术期指标(手术时间、术中出血量、术后首次下床时间、住院时间),术后并发症,术后不同时间结石清除率及随访期间复发率。结果:联合组患者术中出血量、术后首次下床时间、住院时间明显优于对照组,差异均有统计学意义(P<0.05);联合组患者术后1、3、7、15 d及1个月结石清除率均高于对照组,差异均有统计学意义(P<0.05);联合组患者术后并发症总发生率为4.00%,明显少于对照组的16.00%,差异有统计学意义(P<0.05);联合组患者术后12个月随访期复发率与总复发率分别为0、2.00%,明显低于对照组的10.00%、24.00%,差异均有统计学意义(P<0.05)。结论:针对复杂性上尿路结石患者而言,采取经皮肾镜气压弹道碎石联合输尿管镜钬激光治疗,相比较单纯经皮肾镜气压弹道碎石治疗,可在不增加手术时间的基础上,有效地减少术中出血量,缩短术后首次下床时间与住院时间,减少术后并发症的发生,提高术后结石清除率,降低随访复发率,效果理想。Objective:To observe the therapeutic effect of percutaneous nephroscopic pneumatic lithotripsy combined with ureteroscopic holmium laser in the treatment of complex upper urinary calculi.Method:A total of 100 patients with complicated upper urinary tract stones were treated in our hospital in the near future(from September 2016 to September 2018).They were randomly divided into control group(50 cases)and combination group(50 cases).The control group was treated with holmium laser under ureteroscope,and the combination group was treated with percutaneous nephrolithotomy pneumatic lithotripsy combined with ureteroscopic holmium laser treatment,and the patients were followed up for 1 year.The perioperative indicators(operation time,intraoperative bleeding volume,first time out of bed after operation,length of hospitalization),postoperative complications,stone clearance rate at different time after operation and recurrence rate during follow-up period were compared between the two groups.Result:The amount of bleeding during operation,the first time out of bed after operation and the length of hospitalization in the combined group were significantly better than those in the control group,the differences were statistically significant(P<0.05).The stone clearance rate of the combination group were higher than those of the control group at 1,3,7,15 days and 1 month after operation,the differences were statistically significant(P<0.05).The total incidence of complications in the combined group was 4.00%,significantly less than 16.00%in the control group,the difference was statistically significant(P<0.05).The recurrence rate and the total recurrence rate in the 12-month follow-up period in the combined group were 0 and 2.00%,which were respectively lower than 10.00%and 24.00%in the control group,the differences were statistically significant(P<0.05).Conclusion:Percutaneous nephroscopic pneumatic lithotripsy combined with holmium laser ureteroscope for complicated upper urinary calculi can effectively reduce intraoperative

关 键 词：经皮肾镜 气压弹道碎石 输尿管镜钬激光 联合治疗 复杂性上尿路结石 

分 类 号：R69[医药卫生—泌尿科学]