【作者】 孙辉；

【导师】 李恭会；

【作者基本信息】 浙江大学 ， 外科学（专业学位）， 2015， 硕士

【摘要】 目的：比较多人轮流操作与单人独立操作在输尿管软镜钬激光碎石术(flexible ureteroscopy FURS)中对手术效果及操作者舒适性的不同影响。方法：2014.6-2014.12我院一医疗组收治的计划施行输尿管软镜钬激光碎石术患者65例,术前随机分为多人轮流操作组与单人独立操作组。比较两组病例在手术时间、术中出血量、术后住院日、结石清除率、碎石效率、术后并发症情况及操作医生视疲劳评分、前臂疲劳程度评分等情况上的差异。结果：65例手术均顺利完成,其中多人组35例,单人组30例,两组患者在年龄、性别、患病左右侧、结石最长径、结石体积、结石累及肾下盏病例数等基本术前资料无显著性差异(P>0.05),术中出血量、手术时间、术后住院日、结石清除率(残石≧4mm)等比较无显著性差异(P>0.05),单人组一例患者术后并发前列腺出血,余病例术后恢复良好,无明显并发症发生。多人组和单人组碎石效率分别为：46.13±27.92mm3/min和33.66±14.62mm3/min;视疲劳评分：2.93±1.71和4.67±2.19；前臂疲劳程度评分：2.11±1.08和3.33±1.32均存在统计学意义(P<0.05)。再以碎石时间30min、45min、60min为界分为4个亚组,行亚组分析,当碎石时间≤30min及30-45min(含45min)时,多人组和单人组视疲劳评分及前臂疲劳程度评分未显示出显著性差异(P>0.05)。但当碎石时间为45-60min(含60min)及>60min时,多人组和单人组视疲劳评分及前臂疲劳程度评分均具有统计学差异(P<0.05)。结论：输尿管软镜钬激光碎石术多人轮流操作较单人独立操作可提高碎石效率,当碎石时间大于45分钟时可明显降低操作者疲劳程度,提高操作者舒适性。更多还原

【Abstract】 Objective:To compare multi-person take turns operation and single-person operation different impact on results of operations and operator comfort in flexible ureteroscopic holmium laser lithotripsy.Methods:From June2014to December2014,65patients who were admitted to one medical team of Sir Run Run Shaw Hospital were treated with flexible ureteroscopic holmium laser lithotripsy. They were randomized in multi-person take turns operation group (n=35) and single-person operation group (n=30). Compare the operative time, blood loss, hospitalization days after operation, stone free rate, fragmentation speed, postoperative complications and doctor’s score on eyes and forearm fatigue level.Results:The two groups had no significant difference in age, gender, illness side, stone size, the number of cases whose stone involving the lower calyx.(P>0.05) There was no significant difference between two groups in blood loss, operative time, postoperative hospitalization days, stone free rate.(P>0.05) One case of single-person operation group bled in prostate after operation and others recovered well with no significant complication. The fragmentation speed of multi-person take turns operation group and single-person operation group were:46.13±27.92mm3/min and33.66±14.62mm3/min; visual fatigue score:2.93±1.71and4.67±2.19; forearm fatigue score:2.11±1.08and3.33±1.32were statistically significant (P<0.05).65cases divided into four subgroups according to the fragmentation time. When the fragmentation time was less than or equal to45min, two groups’ visual fatigue score and forearm fatigue score showed no significant difference (P>0.05). However when the fragmentation time was more than45min, two groups’ visual fatigue score and forearm fatigue score showed significant difference (P<0.05).Conclusion:In flexible ureteroscopic holmium laser lithotripsy, multi-person take turns operation can improve the fragmentation speed and also can significantly lower operator fatigue level, improve operator comfort when fragmentation time is longer than45minutes.更多还原