摘要
目的观察生理盐水刺激性利尿形成顺行冲洗在输尿管镜钬激光碎石治疗输尿管上段结石中的临床效果。方法回顾性分析上海交通大学医学院苏州九龙医院泌尿外科因输尿管上段结石行输尿管镜钬激光碎石术的52例患者的相关临床资料。其中34例患者因接台手术,术前可以提前2~3 h充分补液,纳入观察组;18例患者因当日10点前接手术室,无法提前充分补液,纳入对照组。观察组术前2~3 h起到麻醉前快速静脉输注生理盐水750~1000 ml,麻醉开始时静脉推注呋塞米20 mg;对照组常规行输尿管镜钬激光碎石。比较两组患者术中逆行灌注量、术中尿量、手术时间、平均每分钟碎石体积、结石残留和并发症等指标。结果观察组术中总尿量明显多于对照组,平均每分钟碎石体积多于对照组,差异有统计学意义(P<0.05);观察组结石残留率低于对照组,差异有统计学意义(P<0.05);经logistic多因素分析显示,是否刺激性利尿和结石部位是结石残留的独立影响因素,差异有统计学意义(P<0.05)。结论刺激性利尿形成人工顺行冲洗运用于输尿管镜碎石安全有效,术中顺行下排尿量增多有助于改善术野,减少输尿管结石残留。
Objective To observe the clinical effect of anterograde irrigation with normal saline irritant diuresis on the treatment of upper ureteral calculi with ureteroscopic holmium laser lithotripsy.Methods The clinical data for 52 patients who underwent ureteroscopic holmium laser lithotripsy for upper ureteral calculi in the Department of Urology,Suzhou Jiulong Hospital,Shanghai Jiaotong University School of Medicine were retrospectively analyzed.The observation group received a rapid intravenous infusion of750-1000 ml of normal saline 2-3 h before anesthesia and an intravenous bolus of 20 mg of furosemide at the beginning of anesthesia.The control group underwent a routine ureteroscopy and holmium laser lithotripsy.The intraoperative retrograde perfusion volume,intraoperative urine volume,operation time,average lithotripsy volume per minute,residual stone presence,and complications were compared between the two groups.Results The total intraoperative urine volume in the observation group was significantly higher than that in the control group,and the average lithotripsy volume per minute was higher than that in the control group(both P<0.05).The residual rate of stones in the observation group was significantly lower than that in the control group(P<0.05).Logistic multivariate analysis showed that irritant diuresis and calculus location were independent influencing factors for calculus residues(P<0.05).Conclusions Artificial anterograde irrigation with irritant diuresis is safe and effective for ureteroscopic lithotripsy.The increase in antegrade urine output during operation can improve the surgical field and reduce the residual ureteral calculi.
作者
王博
俞江
王翌
杜义恒
戴以恒
朱一飞
王锡智
Wang Bo;Yu Jiang;Wang Yi;Du Yiheng;Dai Yiheng;Zhu Yifei;Wang Xizhi(Department of Urology,Suzhou Jiulong Hospital,Shanghai Jiaotong University School of Medicine,Suzhou,215028,China)
出处
《泌尿外科杂志（电子版）》
2022年第1期31-34,40,共5页
Journal of Urology for Clinicians(Electronic Version)
