作　　者： (周留正）; (陈兵海）; (孙浩）; (潘鹏）; (唐爱国）; (王同冰）;

机构地区： 江苏大学附属医院,江苏镇江212001

出　　处： 《中国医学创新》 2017年第26期1-4,共4页

摘　　要： 目的:对比输尿管软镜鞘和肾镜鞘在肥胖患者输尿管上段结石经皮肾镜碎石术(percutaneous nephrolithotomy PCNL)中的应用,评估输尿管软镜鞘在PCNL处理输尿管上段结石中的临床疗效。方法:选取2015年4月-2016年4月本院治疗的输尿管上段结石(腰椎3、4水平)45例,按照随机数字表法分为软镜鞘组21例和肾镜鞘组24例。软镜鞘组在经皮肾穿刺成功后使用输尿管软镜鞘作为工作通道;肾镜鞘组常规应用肾镜鞘作为工作通道。比较分析两组碎石时间、手术时间、出血量、术后残石率、感染率、输尿管狭窄发生率。结果:软镜鞘组手术时间、碎石时间、术中出血量均低于肾镜鞘组,差异均有统计学意义(P<0.001);两组结石清除率比较,差异无统计学意义(P>0.05);软镜鞘组术后感染发生率低于肾镜鞘组,差异有统计学意义(P<0.05);软镜鞘组输尿管狭窄发生例数少于肾镜鞘组,但差异无统计学意义(P>0.05)。结论:在PCNL处理输尿管上段结石手术中,应用输尿管软镜鞘建立工作通道,可缩短碎石时间、减少出血量及术后感染,值得临床应用。 Objective： To compare the application of the flexible ureteroscope sheath with the nephroscope sheath in the treatment of upper urethral calculi with PCNL for obese patients, and evaluate the clinical efficacy of PCNL with flexible ureteroscope sheath in the treatment of upper ureteral calculi.Method： From April 2015 to April 2016, 45 patients diagnosed as upper ureteral calculi （ L3 or L4 level ） treated in our hospital were selected, and divided into flexible ureteroscope sheath group （ 21 patients ） and renal sheath group （ 24 patients ） .A flexible ureteroscope sheath as a working channel was used in the flexible ureteroscope sheath group after successful percutaneous renopuncture, and the renal sheath was routinely used in renal sheath group.The lithotripsy time, operation time, blood loss, stone-free rate, infection rate and the ureteral stenosis rate of two groups were compared and analyzed.Result： Lithotripsy time, operation time, blood loss of flexible ureteroscope sheath group were lower than those of renal sheath group, the differences were statistically significant （P〈0.001） .There was no significant difference between two groups＇ stone-free rate （ P〉0.05 ） .The incidence of post-operation infection was lower in flexible ureteroseope sheath group compared with renal sheath group, the difference was significant （ P〈0.05 ） .The number of ureteral stenosis rate was lower of flexible ureteroscope sheath group compared with renal sheath group, but there was no significant difference （P〉0.05） .Conclusion： In the treatment of ureteral calculi with PCNL, establishing a working channel by flexible ureteroseope sheath can shorten the lithotripsy time, reduce the blood-loss and post-operation infection, it is worth of clinical application.

关 键 词： 输尿管结石 输尿管软镜鞘