摘要
目的探讨有无负压吸引装置输尿管镜钬激光碎石术治疗输尿管上段结石的疗效。方法分析本院2009年1月-2012年8月治疗的62例输尿管上段结石行钬激光碎石术患者的临床资料，所有患者人院前均留置肾造瘘管，其中20例为一期经皮肾取石术后输尿管残留结石的患者，35例为严重肾积水一期行经皮肾造瘘引流术的患者，7例为输尿管上端结石引起-侧肾感染留置肾造瘘管引流择期手术治疗的患者，根据人院顺序先后，随机分为两组，实验组为有负压吸引装置的输尿管镜下钬激光碎石术患者30例，对照组为无负压吸引装置的输尿管镜下钬激光碎石术患者32例，术中通过肾造瘘管测定肾盂压力的变化，术前及术后检测钠、钾的变化，记录手术时间及术后一周X片检查结石清除情况。结果术中实验组肾盂压力为（93．46±3．56）cmH2O，对照组肾盂压力为（201．13±4．69）cmH2O，两组术中肾盂压力有显著性差异（P〈0．05）。实验组手术时间（30±4．39）min，对照组为（50±5．28）min，术后第三天复查平片，实验组和对照组一次结石清除率分别为98．72％、90．25％，随访6个月，结石排净时间分别为（3±2．5）d、（15．3±9．8）d，术前术后两组患者电解质未见明显变化。结论有、无负压吸引装置输尿管镜下钬激光碎石术对电解质无明显影响，但前者可明显降低术中肾盂压力，使视野清晰，减少结石上移，缩短手术时间，结石清除率高，减少因肾盂压力高而带来的并发症。
Objectives To comparre the therapeutic effect of ureteroscope with holmium laser lithotripsy combine with negative/non - negative pressure suction system. Methods The clinic data of 62 cases（ from Jan. 2009 to Aug. 2012） of upper ureteral calculi by ureteroscope with holmium laser lithotripsy, before admission were indwelling nephrostomy fistula, twenty cases with residual ureteral calculi after pereutaneous nephrolithotomy, 35 pa- tients with severe hydronephresis were deal with nephrostomy drainage, and seven patients with upper uretcral calculi result in renal infection, 62 cases underwent ureteroscope with holmium laser lithotripsy, In 30 cases（ Group A） a negative pressure suction system was used. Without negative pressure suction system underwent in 32 patients（ Group B ）. Renal fistula tube was connected with a urine dynamic detector, before and after operation test the Concentration of Na ＋ and K ＋, record the time of operation, after 3 days, X - ray was used to test calculi. Results Operation was successfully completed in 62 patients, in group A , the average renal pelvic pressure was （93.46 ±3.56） cmH20,in group B, renal pelvic pressure was （201.13 ± 4.69） cmH2 O, the two group have a significant difference（ P 〈 0.05 ）, stone clearance rate was 98.72 % ,90.25 %, there was no significant change in Na ＋ and K ＋ after operation. Conclusions Negative pressure suction system can reduce renal pelvic pressure, decrease the opportunity of fragments refluxed into the pelvis, had a positive meaning for decreasing the incidence of postoperational complications.
出处
《国际泌尿系统杂志》
2013年第3期320-322,共3页
International Journal of Urology and Nephrology
关键词
输尿管结石
碎石术
激光
激光
固体
通气机
负压
Ureteral Calculi
Lithotripsy, Laser
Lasers, Solid - State
Ventilators, Negative Pressure
