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目的:探讨采用国产组合式输尿管软镜(少刚镜~)治疗肾及输尿管上段结石的临床效果和优势。方法:2014年1月~2016年10月收治664例肾结石患者,分别进行进口一体式输尿管软镜和国产组合式输尿管软镜(少刚镜~)联合钬激光治疗。进口一体式软镜碎石治疗患者136例,其中男101例,女35例,年龄19~68岁,平均42.3岁。结石位于肾上盏15例,中盏29例,下盏40例,肾盂52例。结石直径(2.3±0.5)cm。行国产组合式输尿管软镜(少刚镜~)碎石528例,其中男377例,女151例。年龄26~72岁,平均36.6岁。结石位于肾上盏72例,中盏63例,下盏162例,肾盂231例。结石平均直径(2.4±0.5)cm。比较两种输尿管软镜碎石的临床效果及安全性,以及两种输尿管软镜的使用成本。结果:两组患者一般情况差异无统计学意义。进口一体式输尿管软镜碎石组,术中寻及结石134例,结石寻及率98.5%(134/136)。2例患者因盏颈细长过深和IP角度过小而未能找到结石,并改变手术方式。手术时间31~82 min,平均51.7min。术后发热6例,抗感染治疗后好转。无输血、感染性休克、输尿管穿孔或撕脱等严重并发症。术后住院时间2~3d,平均2.1d。4周后行腹部平片(KUB)检查并拔除双J管,124例结石已排净,5例进行二次输尿管软镜碎石后排净,一期结石清除率(SFR)92.6%(124/134),二期结石清除率96.3%(129/134),5例肾下盏结石残余(小于4 mm),无需行外科干预。手术时间27~75min,平均47.5 min。国产组合式输尿管软镜(少刚镜~)组术中寻及结石513例,结石寻及率97.2%(513/528)。术后发热13例,严重出血、感染性休克、肾输尿管穿孔或撕脱等严重并发症。术后住院时间2~3d,平均2.3d。4~6周后行KUB检查并拔除双J管,477例结石已排净,20例进行二次输尿管软镜碎石后排净,SFR为93.0%(477/513),二期结石清除率96.9%(497/513),16例肾下盏结石残余(大小为3~4mm)。与一体式输尿管软镜比较,手术时间、术后住院时间、结石寻及率和无石率、术后并发症发生率均无明显差异。但是,组合式输尿管软镜购置和使用成本更低。结论:国产组合式输尿管软镜(少刚镜~)治疗肾结石具有质轻易于操控、疗效确切、手术安全、耗材成本较低等优点,值得临床推广。
Objective: To investigate the clinical effects and advantages of domestically produced ureteroscopic ureteroscopic treatment of renal and upper ureteral calculi. Methods: From January 2014 to October 2016, 664 nephrolithiasis patients were enrolled. One imported ureteral soft-lens and domestic ureteroscope combined with a small ureteroscope combined with holmium laser were treated respectively. 136 cases of imported soft mirror gravel treatment of patients, including 101 males and 35 females, aged 19 to 68 years, with an average of 42.3 years. Stone in renal upper 15 cases, 29 cases in the light, 40 cases of lower light, 52 cases of renal pelvis. Stone diameter (2.3 ± 0.5) cm. Domestic line combined ureteroscopy (less than mirror ~ ) gravel 528 cases, of which 377 were male and female 151 cases. Age 26 to 72 years, mean 36.6 years old. Stones located in the upper calyx in 72 cases, 63 cases of light, the next light in 162 cases, 231 cases of renal pelvis. The average diameter of stones (2.4 ± 0.5) cm. Compare the clinical efficacy and safety of the two types of ureteroscopic lithotripsy, and the cost of using two kinds of ureteroscope. Results: There was no significant difference between the two groups in general condition. Imported ureteroscopic soft lithotripsy group, 134 patients found stones and stones, stone find and the rate of 98.5% (134/136). Two patients because of cervical slender neck and IP angle is too small to find the stones, and change the surgical approach. The operation time ranged from 31 to 82 minutes with an average of 51.7 minutes. Postoperative fever in 6 cases, anti-infection improved after treatment. No blood transfusion, septic shock, ureteral perforation or avulsion serious complications. Postoperative hospital stay 2 ~ 3d, an average of 2.1d. Four weeks later, KUB examination was performed and double J tube was removed. 124 stones were discharged, 5 patients underwent secondary ureteroscopic lithotripsy, and the rate of primary stone clearance (SFR) was 92.6% (124/134) ), Stage II stone clearance rate 96.3% (129/134), 5 cases of residual renal calyceal stones (less than 4 mm), without surgical intervention. The operation time was 27-75 minutes with an average of 47.5 minutes. Domestic combined ureteroscope (less than the mirror ~ ) group found 513 cases and stones, stone search and the rate of 97.2% (513/528). Postoperative fever in 13 cases, severe bleeding, septic shock, renal ureter perforation or avulsion and other serious complications. Postoperative hospital stay 2 ~ 3d, average 2.3d. 4 to 6 weeks after the KUB examination and removal of double J tube, 477 stones have been discharged net, 20 cases of secondary ureteroscopic lithotripsy, the SFR was 93.0% (477/513), two stone clearance rate of 96.9% (497/513), 16 cases of residual calyceal stones (size of 3 ~ 4mm). Compared with the one-piece ureteroscope, there was no significant difference in the operation time, postoperative hospital stay, stone seeking rate and stoneless rate, and the incidence of postoperative complications. However, the combined ureteral soft lens acquisition and use of lower cost. Conclusion: Domestic combined ureteroscope (less than the mirror ~ ) treatment of kidney stones with light and easy to manipulate, curative effect, surgical safety, lower cost of consumables and other advantages, is worth clinical promotion.