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目的观察并对比体外冲击波碎石术(ESWL)与微创腔镜手术治疗飞行人员上尿路结石的疗效。方法分析2005年9月-2012年9月空军总医院采用ESWL(ESWL组,n=83)和输尿管镜碎石术(URL)、经皮肾碎石术(PCNL)等微创腔镜手术(微创腔镜组,n=32)治疗的115例飞行人员上尿路结石患者的临床资料。ESWL组为接受最多不超过3次ESWL治疗的患者,微创腔镜组为接受3次ESWL治疗后排石失败,最终接受URS或PCNL治疗的患者。结果患者均为男性,年龄36.1±9.1岁,两组飞行人员的结石直径ESWL组为0.68±0.22cm,微创腔镜组为0.78±0.25cm,两组间结石长径差异无统计学意义(P=0.526)。患者飞行合格率ESWL组为68.7%,微创腔镜组为81.3%(其中URL 80.0%,PCNL100.0%),差异有统计学意义(P=0.002)。ESWL治疗肾及输尿管上段、中段和下段结石,患者的飞行合格率分别为64.3%、88.9%、33.3%,差异有统计学意义(P=0.023)。URL治疗输尿管上段、中段和下段结石,患者的飞行合格率分别为71.4%、86.7%、87.5%,差异无统计学意义(P=0.174)。输尿管镜碎石失败的患者中,2例因术中结石反流至肾盂,2例因输尿管末端狭窄进镜困难,1例因结石炎性息肉包裹腔镜难以处理。结论对飞行人员上尿路结石,微创腔镜手术治疗较ESWL更为有效,可帮助飞行人员重返飞行岗位。
Objective To observe and compare the efficacy of extracorporeal shock wave lithotripsy (ESWL) and minimally invasive endoscopic surgical treatment of upper urinary calculi in pilots. Methods Analysis From September 2005 to September 2012, the Air Force General Hospital adopted minimally invasive endoscopic surgery such as ESWL (ESWL group, n = 83) and ureteroscopic lithotripsy (URL) and percutaneous nephrolithotomy (PCNL) Minimally invasive endoscopic group, n = 32) in the treatment of 115 cases of upper urinary tract calculi in patients with clinical data. Patients in the ESWL group were those who received no more than 3 ESWLs and patients in the minimally invasive endoscopic group were those who failed to pass the stone row after three ESWLs and were eventually treated with URS or PCNL. Results The patients were all male with a mean age of 36.1 ± 9.1 years. The diameters of the stones in the two groups were 0.68 ± 0.22 cm in the ESWL group and 0.78 ± 0.25 cm in the minimally invasive endoscopic group. There was no significant difference in the long diameter of the stone between the two groups P = 0.526). The passing rate of patients was 68.7% in the ESWL group and 81.3% in the minimally invasive endoscopic group (80.0% for the URL and 100.0% for the PCNL). The difference was statistically significant (P = 0.002). ESWL treatment of renal and ureteral upper, middle and lower stones, the flight pass rate of patients were 64.3%, 88.9%, 33.3%, the difference was statistically significant (P = 0.023). URL treatment of the upper ureter, middle and lower stones, the passing rate of patients were 71.4%, 86.7%, 87.5%, the difference was not statistically significant (P = 0.174). Of the patients who failed ureteroscopic lithotripsy, 2 were refractory to renal pelvis due to intraoperative stone reflux, 2 were difficult to enter the mirror due to ureteric stenosis, and 1 was difficult to treat because of calculi-laden polyp. Conclusions Surgical treatment of upper urinary tract calculi and minimally invasive endoscopic pneumonoscopy is more effective than ESWL and can help pilots return to flight.