论文部分内容阅读
[摘要] 目的 比较经皮肾镜钬激光碎石与双导管超声碎石的疗效及安全性。 方法 回顾性分析2012年10月~2014年12月我院泌尿外科采用经皮肾镜碎石术治疗136例肾结石患者的临床资料,按碎石取石方式不同分为钬激光碎石组(A组66例)和双导管超声碎石组(B组70例),比较两组患者手术时间、失血量、术后感染发生率、Ⅰ期清石率的差异。 结果 A组手术时间为(85.36±21.52)min,术中出血量为(154.18±33.25)mL,术后感染发生率为13.64%,Ⅰ期清石率为90.91%;B组手术时间为(76.15±20.36)min,术中出血量为(85.66±27.68)mL,术后感染发生率为2.86%,Ⅰ期清石率为92.86%。两组手术时间、失血量、术后感染发生率比较差异有统计学意义(P<0.05),Ⅰ期清石率比较差异无统计学意义(P>0.05)。 结论 经皮肾镜双导管超声碎石术治疗肾结石手术时间短,术后感染、出血并发症少,疗效及安全性优于经皮肾镜钬激光碎石术。
[关键词] 经皮肾镜;钬激光碎石术;Cyberwand双导管;超声碎石术
[中图分类号] R692.4 [文献标识码] B [文章编号] 1673-9701(2015)21-0039-03
[Abstract] Objective To compare the efficiency and safety of percutaneous nephrolithotripsy with holmium laser and dual probe ultrasonic. Mothods The clinical data of 136 renal calculi cases from Oct 2012 to Dec 2014 in the urological department of our hospital were retrospectively reviewed, all patients were divided into the holmium laser group (group A 66 cases) and the dual probe ultrasonic group (group B 70 cases) according to the different lithotriptic methods. The differences of the operation time, the blood loss volum,the postoperative infection rate and the one-stage calculi clearance rate between the two groups were compared. Results For the group A, the operation time was (85.36±21.52)min, the blood loss volum was(154.18±33.25)mL, the postoperative infection rate was 13.64%, the one-stage calculi clearance rate was 90.91%; For the group B, the operation time was (76.15±20.36)min, the blood loss volum was (85.66±27.68)mL, the postoperative infection rate was 2.86%, the one-stage calculi clearance rate was 92.86%. There was a significant difference between the two groups in the operation time,the blood loss volum and the postoperative infection rate (P<0.05),but no significant difference in the one-stage calculi clearance rate(P>0.05). Conclusion Percutaneous nephrolithotomy with dual probe ultrasonic has the advantages of shorter operation time, less complications on postoperative infection and blood loss for the treatment of renal calculi, the efficiency and safety of percutaneous nephrolithotripsy with dual probe ultrasonic surpass that with holmium laser.
[Key words] Percutaneous nephrolithotomy; Holmium laser lithotripsy; Cyberwand dual probe; Ultrasonic lzithotripsy
肾结石是泌尿外科多发病及常见病,包括鹿角形结石、巨大肾结石、无肾积水肾结石、孤立肾结石等复杂肾结石临床亦常见,我院泌尿外科两个专业小组2012年10月~2014年12月期间共有136例肾结石患者行经皮肾镜碎石术,分别采取钬激光碎石取石术或Cyberwand双导管超声碎石清石术,本研究旨在比较两种碎石方法的疗效差异,现报道如下。
1 资料与方法
1.1 一般资料
本研究回顾性分析2012年10月~2014年12月期间泌尿外科收治的肾结石患者共136例,其中男75例,女61例,年龄31~72岁,结石直径>2.5 cm共104例,鹿角形结石58例,双侧巨大肾结石5例,孤立肾结石1例,重复肾重复输尿管结石1例,肾结石合并严重感染8例。术前均行泌尿系彩超和泌尿系CT三维重建检查明确诊断,术前常规行尿培养,合并感染者先行肾穿刺造瘘引流术,应用抗生素抗感染,所有患者具备手术指征,排除手术绝对禁忌证。136例患者经B超引导下建立标准F24皮肾通道成功,66例患者实施钬激光碎石取石术,70例患者实施Cyberwand双导管超声碎石清石术。 [3] Fernstrom I,Johansson B. Percutaneous pyelolithotomy:A new extraction technique[J]. Scand J Urol Nephrol,1976, 10(3):257-259.
[4] 蔡佳荣,孙其鹏,缪斌,等. 微创经皮肾镜取石术治疗肾结石的临床研究[J]. 中国现代医生,2014,52(27):27-29.
[5] 韩新军,李中学,涂小峰,等. 经皮肾镜取石术治疗肾结石60例临床观察[J]. 中国现代医生,2013,51(15):44-45.
[6] 李天,李逊,何永忠,等. 经皮肾镜下双频双导管碎石系统治疗肾脏铸型感染性结石[J]. 中国内镜杂志,2012,18(8):855-857.
[7] Zhong P,Tong HL,Cocks FH,et al. Transient cavitation and acoustic emission produced by different laser lithotriptors[J]. J Endourol,1998,12(4):371-378.
[8] Vignali C,Lonzi S,Bargellini I,et al. Vascular injuries after percutaneous renal procedures treatment by transcatheter embolization[J]. Eur Radilo,2004,14(4):723-729.
[9] Kim SC,Matlaga BR,Tinmouth WW,et al. In vitro assessment of a novel dual probe ultrasonic intracorporeal lithotripter[J]. J Urol,2007,177(4):1363-1365.
[10] Xu Y,Wu Z,Yu J,et al. Doppler ultrasound-guided percutaneous nephrolithotomy with two-step tract dilation for management of complex renal stones[J]. Urology,2012, 79(6):1247-1257.
[11] 王海明,许宁,陈岐辉,等. 经皮肾镜钬激光碎石术与双导管超声碎石术治疗鹿角型结石的比较[J]. 中华腔镜泌尿外科杂志(电子版),2013,7(6):35-37.
[12] 牛凌卫,张海芳,柳红美,等. 微创经皮肾镜取石术患者术后感染性休克的临床诊断及治疗[J]. 中华医院感染学杂志,2014,24(14):3562-3563.
(收稿日期:2015-04-30)
[关键词] 经皮肾镜;钬激光碎石术;Cyberwand双导管;超声碎石术
[中图分类号] R692.4 [文献标识码] B [文章编号] 1673-9701(2015)21-0039-03
[Abstract] Objective To compare the efficiency and safety of percutaneous nephrolithotripsy with holmium laser and dual probe ultrasonic. Mothods The clinical data of 136 renal calculi cases from Oct 2012 to Dec 2014 in the urological department of our hospital were retrospectively reviewed, all patients were divided into the holmium laser group (group A 66 cases) and the dual probe ultrasonic group (group B 70 cases) according to the different lithotriptic methods. The differences of the operation time, the blood loss volum,the postoperative infection rate and the one-stage calculi clearance rate between the two groups were compared. Results For the group A, the operation time was (85.36±21.52)min, the blood loss volum was(154.18±33.25)mL, the postoperative infection rate was 13.64%, the one-stage calculi clearance rate was 90.91%; For the group B, the operation time was (76.15±20.36)min, the blood loss volum was (85.66±27.68)mL, the postoperative infection rate was 2.86%, the one-stage calculi clearance rate was 92.86%. There was a significant difference between the two groups in the operation time,the blood loss volum and the postoperative infection rate (P<0.05),but no significant difference in the one-stage calculi clearance rate(P>0.05). Conclusion Percutaneous nephrolithotomy with dual probe ultrasonic has the advantages of shorter operation time, less complications on postoperative infection and blood loss for the treatment of renal calculi, the efficiency and safety of percutaneous nephrolithotripsy with dual probe ultrasonic surpass that with holmium laser.
[Key words] Percutaneous nephrolithotomy; Holmium laser lithotripsy; Cyberwand dual probe; Ultrasonic lzithotripsy
肾结石是泌尿外科多发病及常见病,包括鹿角形结石、巨大肾结石、无肾积水肾结石、孤立肾结石等复杂肾结石临床亦常见,我院泌尿外科两个专业小组2012年10月~2014年12月期间共有136例肾结石患者行经皮肾镜碎石术,分别采取钬激光碎石取石术或Cyberwand双导管超声碎石清石术,本研究旨在比较两种碎石方法的疗效差异,现报道如下。
1 资料与方法
1.1 一般资料
本研究回顾性分析2012年10月~2014年12月期间泌尿外科收治的肾结石患者共136例,其中男75例,女61例,年龄31~72岁,结石直径>2.5 cm共104例,鹿角形结石58例,双侧巨大肾结石5例,孤立肾结石1例,重复肾重复输尿管结石1例,肾结石合并严重感染8例。术前均行泌尿系彩超和泌尿系CT三维重建检查明确诊断,术前常规行尿培养,合并感染者先行肾穿刺造瘘引流术,应用抗生素抗感染,所有患者具备手术指征,排除手术绝对禁忌证。136例患者经B超引导下建立标准F24皮肾通道成功,66例患者实施钬激光碎石取石术,70例患者实施Cyberwand双导管超声碎石清石术。 [3] Fernstrom I,Johansson B. Percutaneous pyelolithotomy:A new extraction technique[J]. Scand J Urol Nephrol,1976, 10(3):257-259.
[4] 蔡佳荣,孙其鹏,缪斌,等. 微创经皮肾镜取石术治疗肾结石的临床研究[J]. 中国现代医生,2014,52(27):27-29.
[5] 韩新军,李中学,涂小峰,等. 经皮肾镜取石术治疗肾结石60例临床观察[J]. 中国现代医生,2013,51(15):44-45.
[6] 李天,李逊,何永忠,等. 经皮肾镜下双频双导管碎石系统治疗肾脏铸型感染性结石[J]. 中国内镜杂志,2012,18(8):855-857.
[7] Zhong P,Tong HL,Cocks FH,et al. Transient cavitation and acoustic emission produced by different laser lithotriptors[J]. J Endourol,1998,12(4):371-378.
[8] Vignali C,Lonzi S,Bargellini I,et al. Vascular injuries after percutaneous renal procedures treatment by transcatheter embolization[J]. Eur Radilo,2004,14(4):723-729.
[9] Kim SC,Matlaga BR,Tinmouth WW,et al. In vitro assessment of a novel dual probe ultrasonic intracorporeal lithotripter[J]. J Urol,2007,177(4):1363-1365.
[10] Xu Y,Wu Z,Yu J,et al. Doppler ultrasound-guided percutaneous nephrolithotomy with two-step tract dilation for management of complex renal stones[J]. Urology,2012, 79(6):1247-1257.
[11] 王海明,许宁,陈岐辉,等. 经皮肾镜钬激光碎石术与双导管超声碎石术治疗鹿角型结石的比较[J]. 中华腔镜泌尿外科杂志(电子版),2013,7(6):35-37.
[12] 牛凌卫,张海芳,柳红美,等. 微创经皮肾镜取石术患者术后感染性休克的临床诊断及治疗[J]. 中华医院感染学杂志,2014,24(14):3562-3563.
(收稿日期:2015-04-30)