粤北地区输尿管镜下碎石术日间手术模式的建立和实践

Establishment and practice of day operation mode of ureteroscopic lithotripsy in northern Guangdong

目的:探讨粤北地区将经尿道输尿管镜下碎石术日间手术化的安全有效性。方法:回顾性分析2020年8月至2022年2月在本院收治的638例输尿管结石患者的临床资料,均采用经尿道输尿管镜下碎石术治疗。按患者意愿将患者分为研究组(行日间手术,338例)和对照组(住院手术治疗,300例)。分析两组患者的年龄、结石长径、体质量指数(BMI)、性别、手术时间、住院费用、术前等待时间、住院时间、手术成功率及术后并发症发生率等指标。结果:两组患者的手术时间比较,差异无统计学意义(P>0.05)。研究组的住院费用、术前等待时间、住院时间显著低于对照组,差异均有统计学意义(均P<0.001)。研究组有5例碎石不成功,碎石成功率为98.52%(333/338),8例出现并发症,并发症发生率为2.37%(8/338)。对照组有4例碎石不成功,碎石成功率为98.67%(296/300),6例出现并发症,并发症发生率为2.00%(6/300),两组患者的碎石成功率、术后并发症发生率比较,差异均无统计学意义(χ^(2)=0.021、0.102,P=0.881、0.753)。结论:把握手术适应证的条件下,术前充分评估与准备,熟练规范的操作,日间手术模式下的经尿道输尿管镜下碎石术是安全可行的,并且可以降低住院费用,缩短住院时间,值得临床推广。

Objective To investigate the safety and effectiveness of transurethral ureteroscopic lithotripsy in northern Guangdong province.Methods The clinical data of 638 patients with ureteral calculi admitted to our hospital from August 2020 to February 2022 were retrospectively analyzed,all of whom were treated by transurethral ureteroscopic lithotripsis.The patients were divided into study group(day operation,338 cases)and control group(inpatient operation,300 cases).The indexes of age,stone length,body mass index(BMI),gender,operation time,hospitalization cost,preoperative waiting time,hospital stay,operation success rate and postoperative complication rate of the two groups were analyzed.Results There was no significant difference in operation time between the two groups(P<0.05).The hospitalization cost,preoperative waiting time and hospital stay of the study group were significantly lower than those of the control group,and the differences were statistically significant(P<0.001).In the study group,5 cases were unsuccessful in lithotomy,the success rate was 98.52%(333/338),8 cases had complications,the complication rate was 2.37%(8/338).In the control group,4 patients were unsuccessful in lithotomy,the success rate of lithotomy was 98.67%(296/300),and 6 patients had complications,the complication rate was 2.00%(6/300).There was no significant difference in the success rate of lithotomy and the incidence of postoperative complications between the two groups(χ^(2)=0.021,0.102,P=0.881,0.753).Conclusions Transurethral ureteroscopic lithotripsy is safe and feasible under the condition of understanding surgical indications,adequate preoperative evaluation and preparation,skilled and standardized operation,and day surgery mode,which can reduce hospitalization costs and shorten hospitalization time,and is worthy of clinical promotion.