微肾镜联合大功率钬激光治疗复杂肾结石的疗效观察

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1、授予单位代码10089学号或申请号13061HebeiMedicalUniversity硕士学位论文在职科学学位微肾镜联合大功率钬激光治疗复杂肾结石的疗效观察学位申请人：于汝通导师：张爱莉教授专业:外科学2015年3月河北医科大学学位论文使用授权及知识产权归属承诺本学位论文在导师(或指导小组)的指导下,由本人独立完成。本学位论文研究所获得的研究成果,其知识产权归河北医科大学所有。河北医科大学有权对本学位论文进行交流、公开和使用。凡发表与学位论文主要内容相关的论文,第一署名为单位河北医科大学，试验材料、原始数据、申报的专利等知识产权均归河北医科大学所有。否则,承担相应法律责任。研究生

2、签名导师签院领.y上年_1>月丫曰':、/河北医科大学研究生学位论文独创性声明本论文是在导师指导下进行的研究工作及取得的研究成果,除了文中特别加以标注和致谢等内容外,文中不包含其他人已经发表或撰写的研究成果，指导教师对此进行了审定。本论文由本人独立撰写，文责自负。研究生签名导师签章：^年t月XT日目录中文摘要·············································································1英文摘要·························································

3、····················2研究论文微肾镜联合大功率钬激光治疗复杂肾结石的疗效观察前言·············································································4材料与方法····································································5结果·············································································7附表··········

4、···································································8讨论·············································································9结论·············································································14参考文献·····························································

5、··········14综述复杂肾结石的治疗进展··················································17致谢···················································································29个人简历·············································································3022中文摘要微肾镜联合大功率钬激光治疗复杂肾结石的疗效观察摘要目的：探讨微肾镜联合大功率钬激光治

6、疗复杂肾结石的疗效及安全性。方法：收集复杂肾结石患者50例，采用微肾镜联合大功率钬激光治疗，观察患者的手术时间、术中出血量、一次结石取净率、尿液转清时间、术后住院时间及并发症发生情况；观察患者血肌酐、尿素氮变化情况；术后随访记录结石复发情况。结果：本组50例患者，一次手术结石取净率为78.0%。转开放手术取石率为4%。接受二期碎石或取石占10%。术中无胸膜损伤及肠管损伤等严重并发症发生。手术时间（67.5±10.7）min。术后尿液转清的平均时间（41.3±2.6）h。术后住院天数（8.2±1.4）d。肾造瘘管留置时间（6.5±1.2）d，尿管留置时间（4.8±2.1）d。所有患者

7、未行双通道或多通道取石。随访（3.8±1.4）个月。术后2h、术后24h、术后7d时患者血肌酐、尿素氮水平均较术前明显增高(P<0.05)，术后24h达峰值，随后开始下降，至术后30d时降至术前水平。结论：微肾镜联合大功率钬激光治疗复杂肾结石，可有效提高碎石、取石效率，缩短患者住院时间，并发症少，对肾脏结构及功能损伤小，大多数患者血肌酐、尿素氮水平在术后7d下降，术后30d回复正常，表明该术式安全可靠。术前、术中、术后应注意相关并发症的预防及治疗，如此可有效降低并发症