经皮肾镜手术治疗输尿管上段嵌顿结石患者50例的临床分析

Clinical analysis of 50 cases of upper ureteral calculi treated by percutaneous nephrolithotomy

目的研究经皮肾镜手术治疗输尿管上段嵌顿结石患者的临床疗效。方法回顾性分析湖北医药学院附属人民医院泌尿外科在2014年5月1日至2017年5月1日接诊的100例输尿管上段嵌顿结石患者的诊疗情况。按照手术方式不同,分为观察组和对照组,每组各50例。观察组采用经皮肾镜手术进行治疗,对照组采用传统的经尿道输尿管镜碎石术进行治疗,比较2组患者的手术时间、术后出血量、住院时间、碎石成功率、术后7 d的结石清除率、术后30 d的结石清除率、血培养阳性率以及术后并发症发生率。结果观察组患者手术出血量明显多于对照组,观察组手术时间、住院时间均明显长于对照组,2组比较差异有统计学意义(P <0. 05)。2组患者手术效果相比,观察组碎石成功率(100%)明显高于对照组(80%),观察组术后7 d结石清除率(92%)明显高于对照组(60%),观察组术后30 d结石清除率(100%)明显高于对照组(84%),2组比较有统计学意义(P <0. 05)。观察组血培养阳性率(2%)低于对照组(6%),但2组比较差异无统计学意义(P> 0. 05)。术后并发症总发生率观察组(14%)明显小于对照组(46%),差异有统计学意义(P <0. 05)。结论经皮肾镜手术对治疗输尿管上段嵌顿结石患者临床效果明显,并发症少,值得临床推广。

Objective To investigate the clinical efficacy of percutaneous nephrolithotomy in the treatment of upper ureteral calculi. Methods A retrospective analysis was performed on the 100 patients with upper ureteral calculi admitted into the Urinary Surgical Department, People＇s Hospital Affiliated to Hupei Pharmaceutical College from May 1, 2014 to May 1, 2017. The patients were divided into the observation group and the control group in accordance with different surgical methods, each consisting of 50 patients. The observation group was treated by percutaneous nephrolithotomy, and the control group underwent traditional ureteroscopic lithotripsy. Surgical time, amount of hemon＇hage, hospitalization days, success rate of lithotripsy, calculus clearance rate 7 days after surgery, calculus clearance rate 30 days after surgery, positive rate of blood culture and rate of complications after surgery were compared between the 2 groups. Results The amount of hemorrhage in the observation group was also obviously higher than that of the control group. Surgical time and hospitalization days of the observation group were significantly longer than those of the control group, and statistical significance could be noted, when comparisons were made between the 2 groups （ P 〈 0.05 ）. When comparisons were made with respect to surgical effects, the success rate of lithotripsy in the observation group （ 100% ） was significantly higher than that of the control group（ 80% ） , the calculus clearance rate in the observation group 7 days after surgery was markedly higher than that of the control group （92% vs 60% ）, and the calculus clearance rate in the observation group （100%）30 days after surgery was obviously higher than that of the control group（ 80% ） , and statistical significance could be noted when comparisons were made between the 2 groups （P 〈 0. 05）. The positive rate of blood culture in the observation group （2%） was lower than that of the control group （6%）, but withoutstatistical significance（ P 〈 0.05 ）. The total rate of complications （ 14% ） after surgery in the observation group was significantly lower than that of the control group （46 % ）, with statistical significance （ P 〈 0.05 ）. Conclusion Percutaneous nephrolithotomy in the treatment of upper ureteral calculi could produce significant clinical effects with less complications, and is worth further clinical popularization.