不同体位下输尿管硬镜对输尿管上段结石患者的疗效及安全性分析  

Efficacy and Safety Analysis of Rigid Ureteroscope in Different Positions for Patients with Upper Ureteral Calculi

作　　者：刘绍辉 王青杰 王海 孙卫星 张学峰 LIU Shao-hui;WANG Qing-jie;WANG Hai;SUN Wei-xing;ZHANG Xue-fang(Urinary Surgery,Hospital of Integrated Traditional Chinese and Western Medicine,Beijing University of Chinese Medicine,Beijing,100039,China;General surgery,Hospital of Integrated Traditional Chinese and Western Medicine,Beijing University of Chinese Medicine,Beijing,100039,China)

机构地区：[1]北京中医药大学附属中西医结合医院泌尿外科,北京100039 [2]北京中医药大学附属中西医结合医院普外科,北京100039

出　　处：《现代生物医学进展》2022年第8期1480-1483,1465,共5页Progress in Modern Biomedicine

基　　金：北京中医药科技发展基金项目(JJ2016-16);吴阶平医学基金项目(320.6750.2020-06-9)。

摘　　要：目的:对比不同体位下输尿管硬镜对输尿管上段结石患者的疗效及安全性。方法:2018年8月到2021年1月选择在本院诊治的输尿管上段结石的患者88例作为研究对象,根据随机信封抽签1:1原则把患者分为头高臀低组与水平位组各44例。所有患者均给予输尿管硬镜手术治疗,头高臀低组给予头高臀低截石位,水平位组给予水平截石位,记录与随访疗效及安全性。结果:所有患者顺利完成手术,头高臀低组碎石时间等围手术指标少于水平位组(P<0.05)。头高臀低组术后14 d的总有效率为97.7%,高于水平位组的86.4%(P<0.05)。头高臀低组术后14 d的假道形成、输尿管穿孔、粘膜撕脱、感染等总发生率为4.5%,低于水平位组的25.0%(P<0.05)。两组术后14 d的血清同型半胱氨酸(Hcy)和β2-微球蛋白(β2-MG)含量较术前1 d低(P<0.05),头高臀低组低于水平位组(P<0.05)。所有患者术后随访6个月,头高臀低组的复发率为2.3%,低于水平位组的13.6%(P<0.05)。结论:相对水平截石位,头高臀低截石位在输尿管上段结石患者输尿管硬镜手术患者的应用能提高总体治疗效果,促进患者康复,也可降低血清同型半胱氨酸和β2-微球蛋白,减少并发症的发生,降低复发率。Objective: To compare the efficacy and safety of rigid ureteroscope in different positions for patients with upper ureteral calculi. Methods: From August 2018 to January 2021, 88 cases of patients with upper ureteral calculi diagnosed and treated in our hospital were selected as subjects, and the patients were equally divided into head-high butt-low group and horizontal position group accorded to the 1:1 principle of random envelope drawing. example. All patients were treated with rigid ureteroscopy. The head-high butt-low group were given head-high buttock-low lithotomy position, and the horizontal group were given horizontal lithotomy position. The efficacy and safety of the two groups were recorded and followed up. Results: All patients were successfully completed the operation. The lithotripsy time, stone clearing time and postoperative hospital stay in the head-high-but-low group were less than those in the horizontal group(P<0.05). The total effective rates of the head-high butt-low group were 97.7 % at 14 days after surgery, which were higher than86.4 % in the horizontal group(P<0.05). The incidence rates of complications such as false canal formation, ureter perforation, mucosal avulsion, infection and other complications in the head-high-but-low group were lower than those in horizontal group(P<0.05). The levels of serum homocysteine and β2-microglobulin in the two groups at 14 days after operation were lower than those in the preoperative 1 day(P<0.05), and the head-high but low-butt-low group were lower than the horizontal group(P<0.05). All patients were followed up for 6months after the operation, the recurrence rate of the head-high-but-low group were 2.3 %, which were lower than the 13.6 % of the horizontal group(P<0.05). Conclusion: Compare to the horizontal lithotomy position, the application of the head-high butt-low lithotomy position in patients with upper ureteral calculi with rigid ureteroscopy can promote the recovery of patients, improve the overall therapeutic effect, and reduce serum ho

关 键 词：水平截石位 头高臀低截石位 输尿管上段结石 输尿管硬镜 

分 类 号：R691.4[医药卫生—泌尿科学]