摘要
目的探讨经皮肾镜碎石术(PCNL)联合输尿管软镜治疗老年输尿管上段嵌顿性结石的临床效果。方法选择2015年3月至2016年10月海南医学院第二附属医院收治的输尿管上段嵌顿性结石老年患者80例,根据治疗方法分为观察组和对照组,每组40例。对照组患者给予PCNL治疗,观察组患者给予PCNL联合输尿管软镜治疗,对2组患者的手术时间、住院时间、结石排净时间、术后1个月结石清除率、并发症及术后第1、3、5天血清C反应蛋白(CRP)水平进行比较。结果观察组患者手术时间长于对照组,住院时间及结石排净时间短于对照组(P<0.05);术后1个月,观察组和对照组患者结石清除率分别为100.0%(40/40)、80.0%(32/40),观察组患者结石清除率高于对照组(χ2=6.806,P<0.05)。观察组患者血尿、发热、肺部感染、输尿管损伤发生率及总并发症发生率分别为5.0%(2/40)、2.5%(1/40)、2.5%(1/40)、2.5%(1/40)、12.5%(5/40),无肾绞痛患者;对照组患者血尿、发热、肺部感染、输尿管损伤、肾绞痛发生率及总并发症发生率分别为10.0%(4/40)、10.0%(4/40)、5.0%(2/40)、20.0%(8/40)、15.0%(6/40)、60.0%(24/40);2组患者血尿、发热及肺部感染发生率比较差异无统计学意义(χ2=0.180、0.853、0.000,P>0.05),观察组患者输尿管损伤、肾绞痛发生率及总并发症发生率低于对照组(χ2=4.336、4.505、19.527,P<0.05)。2组患者术前血清CRP水平比较差异无统计学意义(P>0.05),2组患者术后第1、3天血清CRP水平高于术前(P<0.05);对照组患者术后第5天血清CRP水平高于术前(P<0.05),观察组患者术后第5天与术前血清CRP水平比较差异无统计学意义(P>0.05);术后第1、3、5天,观察组患者血清CRP水平低于对照组(P<0.05)。结论 PCNL联合输尿管软镜治疗输尿管上段嵌顿性结石具有结石清除率高、并发症发生率低、手术损伤小等优势。
Objective To investigate the clinical effect of percutaneous nephrolithotomy(PCNL)combined with flexible ureteroscope in the treatment of elderly patients with incarcerated upper ureteric calculus.Methods A total of 80 elderly patients with incarcerated upper ureteric calculus in the Second Affiliated Hospital of Hainan Medical University from March 2015 to October 2016 were selected as the subjects.The patients were divided into observation group and control group according to the treatment method,with 40 cases in each group.The patients in the control group were treated with PCNL,and the patients in the observation group were treated with PCNL combined with flexible ureteroscopy.The operation time,hospitalization time,stone clearance time,stone clearance rate at one months after operation,complications and the level of serum C-reactive protein(CRP)on the first,third,fifth day after operation were compared between the two groups.Results The operation time in the observation group was longer than that in the control group,and the hospitalization time and stone clearance time in the observation group were shorter than those in the control group(P<0.05).One month after operation,the stone clearance rate in the observation group and the control group was 100.0%(40/40)and 80.0%(32/40)respectively,the stone clearance rate in the observation group was higher than that in the control group(χ2=6.806,P<0.05).The incidences of hematuria,fever,pulmonary infection,ureteral injury and total complications were 5.0%(2/40),2.5%(1/40),2.5%(1/40),2.5%(1/40)and 12.5%(5/40)in the observation group respectively,and there was no patient with renal colic.The incidences of hematuria,fever,pulmonary infection,ureteral injury,renal colic and total complications were 10.0%(4/40),10.0%(4/40),5.0%(2/40),20.0%(8/40),15.0%(6/40)and 60.0%(24/40)in the control group respectively.There was no significant difference in the incidences of hematuria,fever and pulmonary infection between the two groups(χ2=0.180,0.853,0.000;P>0.05).The incidences of ureteral injury,renal colic and total complications in the observation group were lower than those in the control group(χ2=4.336,4.505,19.527;P<0.05).There was no significant difference in serum CRP level between the two groups before operation(P>0.05).The serum CRP level on the first,third,fifth day after operation was higher than that before operation in the two groups(P<0.05).The serum CRP level on the fifth day after operation was higher than that before operation in the control group(P<0.05).There was no significant difference in serum CRP level between the fifth day after operation and before operation in the observation group(P>0.05).The serum CRP level in the observation group was lower than that in the control group on the first,third,fifth day after operation(P<0.05).Conclusion PCNL combined with flexible ureteroscope for the treatment of incarcerated upper ureteric calculus has advantages of high stone clearance rate,low incidence of complication and less surgical injury.
作者
徐磊
车宪平
古军
XU Lei;CHE Xian-ping;GU Jun(Department of Urinary Surgery,the Second Affiliated Hospital of Hainan Medical University,Haikou 570311,Hainan Province,China)
出处
《新乡医学院学报》
CAS
2018年第7期597-600,共4页
Journal of Xinxiang Medical University
关键词
输尿管结石
嵌顿性结石
经皮肾镜碎石术
输尿管软镜
ureteral calculus
incarcerated calculus
percutaneous nephrolithotomy
flexible ureteroscope
