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目的观察多镜联合治疗急性复杂性尿路结石梗阻的疗效。方法回顾性分析236例应用输尿管硬镜、输尿管软镜和经皮肾镜治疗急性复杂性尿路结石梗阻患者的临床资料,其中使用两种或两种以上内镜联合治疗的患者176例(多镜联合组),采用单一内镜下治疗患者60例(单一镜组)。比较两组手术时间、住院时间、一期结石清石率、炎性反应程度、手术并发症等指标。结果 236例均成功解除梗阻,无1例改开放手术,无输尿管完全撕脱断裂、肾脏大出血等严重并发症。与单一镜组比较,多镜联合组住院时间缩短(t=1.371,P=0.046),一期清石率升高(t=0.426,P=0.035),需2期或3期经皮肾穿刺取石术(percutaneous nephrolithotomy,PCNL)患者(χ~2=41.183,P<0.001)、术后中性粒细胞比率(χ~2=2.375,P=0.029)和C反应蛋白值(χ~2=107.102,P<0.001)均降低,差异均有统计学意义。两组手术时间、输血情况、发热情况比较,差异均无统计学意义。结论多镜联合下治疗急性复杂性尿路结石梗阻具有净石率高、住院时间短、一期解除梗阻率高,术后炎性反应低等优点,同时安全、微创,值得临床推广应用。
Objective To observe the curative effect of multi-mirror combined treatment of acute complicated urolithiasis. Methods A retrospective analysis of 236 patients with ureteral calculi, ureteroscopic and percutaneous nephrolithotomy in patients with acute complications of urinary tract obstruction clinical data, including the use of two or more than two endoscopic treatment of patients with 176 cases (more Mirror combined group), using a single endoscopic treatment of patients 60 cases (single mirror group). The operation time, hospitalization time, the rate of primary stone clearing, the degree of inflammatory reaction and the complication of operation were compared between the two groups. Results All 236 cases were successful in obstruction, none of them changed to open surgery, no complete ureter rupture and renal hemorrhage and other serious complications. Compared with the single group, the hospitalization time was shorter in the multi-mirror combination group (t = 1.371, P = 0.046), the rate of first stage was higher (t = 0.426, P = 0.035) The percentage of postoperative neutrophil (χ ~ 2 = 2.375, P = 0.029) and C reactive protein (χ ~ 2 = 107.102) in patients with percutaneous nephrolithotomy (PCNL) , P <0.001), the differences were statistically significant. Two groups of operation time, blood transfusion, fever, the difference was not statistically significant. Conclusions Multi-mirror combined with the treatment of acute complex urinary stone obstruction has the advantages of high net-stone rate, short hospitalization time, high obstruction rate in the first phase and low postoperative inflammatory response. It is also safe and minimally invasive and worthy of clinical application.