本文選題：腎結石 + 輸尿管軟鏡��； 參考：《廣州醫(yī)科大學》2014年碩士論文

【摘要】：研究目的 對比分析術前是否留置雙J管對行經尿道輸尿管軟鏡碎石取石術患者的療效，安全性的影響。 研究方法 前瞻性對2013年11月至2014年3月60例行經尿道輸尿管軟鏡碎石取石術的結石患者進行隨機分組對照試驗。每組30例，一組做好術前準備后直接行經尿道輸尿管軟鏡碎石取石術（A組），另一組于入院當日局麻下予留置輸尿管雙J管1周后行經尿道輸尿管軟鏡碎石取石術（B組），放置輸尿管軟鏡通道鞘困難者予擴張輸尿管，仍不成功者則改行經皮腎鏡取石術或體外碎石術。對兩組患者需要擴張輸尿管所占比例，手術時間，住院時間，住院費用，術中術后并發(fā)癥，術后1-2天及1個月后結石清除率等數(shù)據進行統(tǒng)計分析比較。 研究結果 本課題60例患者均成功I期行經尿道輸尿管軟鏡碎石取石術，兩組患者術中均未出現(xiàn)輸尿管撕裂、斷裂、穿孔、黏膜脫套及大出血等并發(fā)癥。A組需要擴張輸尿管的有6例，3例先予以輸尿管筋膜擴張器擴張，不能擴張至F14，遂用輸尿管球囊擴張器擴張輸尿管至21F，余下3例均應用輸尿管筋膜擴張器擴張至14F，B組有1例予以輸尿管筋膜擴張器擴張至14F。兩組一次性放置軟鏡通道鞘成功率分別為24/30(80%)、29/30(96.67%),兩組輸尿管一次性放置軟鏡通道鞘成功率差異比較無統(tǒng)計學意義。A組手術時間分別為78.3740.35min，B組分兩次手術，局麻下逆行插管手術時間平均為13.776.88min，Ⅱ期平均手術時間為8032.85min；總手術時間平均為93.7736.03min。兩組手術時間差異比較無明顯統(tǒng)計學意義。全部病例術后均常規(guī)留置F6或F8雙J管1條。A、B兩組術后1-2天結石清除率分別為18/30（60%）、17/30（56.67%），兩組患者術后無一例出現(xiàn)體溫＞38.5℃，無膿毒血癥的出現(xiàn)，全部病例術后均未出現(xiàn)因大出血需要輸血者。住院治療費用分別為19675.982880.03元、21060.566068.02元，差異無統(tǒng)計學意義。住院時間分別為6.71.74天、11.73.72天，差異比較有統(tǒng)計學意義，可明顯縮短患者住院時間。術后1個月結石清除率兩組分別為29/30(96.67%)、28/30(93.33%)，術后1個月結石清除率差異比較無統(tǒng)計學意義，A組中有一例患者術后1個月出現(xiàn)輸尿管石街，再次入院行輸尿管鏡取石術。 結論 經尿道輸尿管軟鏡碎石取石術前可不用常規(guī)預先留置輸尿管雙J管1-2周，手術安全有效，但需具備輸尿管擴張器械（筋膜擴張器及球囊擴張器）等條件及技術。
[Abstract]:Objective to compare the effect and safety of double J tube before operation on patients undergoing transurethral soft ureteroscopy lithotripsy. Methods A prospective randomized controlled trial was conducted on 60 patients undergoing transurethral soft ureteroscopic lithotripsy from November 2013 to March 2014. 30 cases in each group, One group received direct transurethral soft ureteroscopy lithotripsy after preoperative preparation (group A), the other group received ureteral double J tube lithotripsy under local anesthesia on the day of admission (group B), and the other group underwent transurethral ureteral lithotripsy (group B) after 1 week of indwelling ureteral double J tube (group B). The ureter was dilated by dilatation of ureteral soft tunnel sheath. Those who still failed were treated with percutaneous nephrolithotomy or extracorporeal lithotripsy. The ratio of ureteral dilation, operation time, hospitalization cost, postoperative complications, stone clearance rate of 1-2 days and 1 month after operation were analyzed and compared between the two groups. Results all 60 patients were successfully treated with transurethral ureteral lithotripsy. No ureteral laceration, rupture or perforation were found in both groups. In group A, 6 cases needed to dilate ureter and 3 cases were treated with ureteral fascia dilator dilatation. The ureteral fascia dilator was used to dilate the ureter to 21F with ureteral balloon dilator. One case in group B was dilated to 14F with ureteral fascia dilator. The successful rate of soft mirror sheath placement in two groups was 24 / 30 (80%) 29 / 30 (96.67%) respectively. There was no significant difference between two groups. The operative time of group A was 78.3740.35 min. The average time of retrograde intubation under local anesthesia was 13.776.88 min, that of stage 鈪，

本文編號：2105809