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输尿管软镜钬激光碎石取石术并发症的原因及对策 被引量:12

Causes and countermeasures of complications following retrograde intrarenal surgery lithotripsy with holmium laser
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摘要 目的:分析输尿管软镜钬激光碎石术(RIRS)手术相关并发症发生的原因,探讨并发症的危险因素以及预防和处理对策。方法:收集2015年7月-2017年12月采用RIRS治疗上尿路结石共603例患者的基本资料,对结石大小、结石部位数、结石个数、手术时间、肾积水程度、结石清除率、手术并发症发生率等进行统计学分析。结果:603例患者一期手术成功率84.4%,术后4周结石清除率89.7%,手术并发症发生率3.8%,无中转开放手术的病例,无死亡病例。根据术后并发症发生情况,将603例分为并发症组和非并发症组进行单因素分析,两组在年龄、结石部位数、结石个数、肾积水程度方面差异无统计学意义(P>0.05),在性别、结石大小、是否预留输尿管支架管和手术时间方面差异有统计学意义(P<0.05);多因素Logistic回归分析发现性别、结石大小、是否预留输尿管支架管和手术时间是RIRS并发症发生的危险因素。结论:RIRS是治疗上尿路结石的有效方法,手术创伤小,并发症发生率低,通过预留输尿管支架管、缩短手术时间和选择中等大小的上尿路结石进行手术可减少并发症的发生。 Objective:To analyze the causes of complications related to ureteroscopic holmium laser lithotripsy,and to explore the risk factors of complications and the countermeasures for prevention and treatment.Methods:603 cases of upper urinary tract calculi treated by retrograde intrarenal surgery(RIRS)in our department from July 2015 to December 2017 were reviewed.The basic data,stone size,number of stone sites,number of stones,operation time,hydronephrosis degree,stone clearance rate and incidence of surgical complications were statistically analyzed.Results:The success rate of the first-stage operation in 603 patients was 84.4%,the stone clearance rate was 89.7%at 4 th week after operation,and the incidence of surgical complications was 3.8%.There were no cases of conversion to open surgery and no deaths.According to the occurrence of postoperative complications,603 cases were divided into complications group and non-complications group for single factor analysis.There was no significant difference in age,number of stone sites,number of stones and degree of hydronephrosis between the two groups(P>0.05).There was significant difference in gender,stone size,whether ureteral stent was reserved or not and operation time(P<0.05).Multivariate Logistic regression analysis revealed that gender,stone size,whether to reserve ureteral stent and operation time were risk factors for complications of ureteroscopic holmium laser lithotripsy.Conclusion:Flexible ureteroscope holmium laser lithotripsy is an effective method for the treatment of upper urinary tract calculi,with less surgical trauma and low incidence of complications.The occurrence of complications can be reduced by reserving ureteral stent,shortening the operation time and selecting medium-sized upper urinary tract calculi for surgery.
作者 郑彬 张贺庆 顾志文 陈岳 詹河涓 ZHENG Bin;GU Zhiwen;ZHANG Heqing;CHEN Yue;ZHAN Hejuan(Department of Urology,Chancheng Central Hospital of Foshan,Foshan 528031,China)
出处 《微创泌尿外科杂志》 2019年第4期252-256,共5页 Journal of Minimally Invasive Urology
基金 2017年广东省医学科学技术研究基金项目(B2017043) 2017年佛山市医学类科技攻关项目(2017AB002381) 2018佛山市卫生和计生局医学科研项目(20180179).
关键词 输尿管软镜 肾结石 输尿管结石 上尿路结石 并发症 flexible ureteroscopy renal calculi ureteral calculi upper urinary tract calculi complications
作者简介 通信作者:郑彬,2627929713@qq.com
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