腹腔镜肾盂输尿管成形术围手术期的创伤控制研究

发布时间：2018-01-26 08:31

本文关键词： 腹腔镜肾盂输尿管成形术酸碱平衡引流　出处：《重庆医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的分析腹腔镜肾盂输尿管成形术后机体血气分析检测结果，探讨CO_2气腹对儿童机体酸碱平衡的影响因素及其防治措施；评价术后肾盂尿液不同引流方式的优缺点及适应症。方法①选择腹腔镜及开放式肾盂输尿管成形术各64例患儿，分为腹腔镜组和开放组。按年龄分别分为婴幼儿组、学龄前组和学龄组。另选择腹腔镜肾盂输尿管成形术26例患儿，在手术结束时，采取用空气完全置换腹腔残余CO_2措施，作为腹腔镜干预组。所有患儿均于术后4小时行动脉血气分析检测。比较腹腔镜组和开放组、腹腔镜组和腹腔镜干预组术后高碳酸血症发生率差异；比较不同年龄段患儿术后酸碱失衡发生率差异。②选择腹腔镜肾盂输尿管成形术90例患儿，分为肾造瘘体外引流组、长时间双J管体内引流组、短时间双J管体内引流组。比较三组术后并发症及术后成功率的差异。结果 ①腹腔镜组术后高碳酸血症发生率高于开放组（P0.05），两组代谢性酸中毒发生率比较，无显著性差异（P0.05）。 ②随着年龄的增长，腹腔镜组与开放组术后酸碱失衡发生率均呈逐渐下降的趋势。腹腔镜组酸碱失衡发生率：婴幼儿组明显高于学龄期组（P0.01），学龄前期组高于学龄期组（P0.05），婴幼儿组与学龄前期组比较，无显著性差异（P0.05）。开放组酸碱失衡发生率：婴幼儿组明显高于学龄期组（P0.01），学龄前期组高于学龄期组（P0.05），婴幼儿组与学龄前期组比较，无显著性差异（P0.05） ③腹腔镜干预组术后高碳酸血症发生率低于腹腔镜组（P0.05），两组代谢性酸中毒发生率比较，，无显著性差异（P0.05）。 ④肾造瘘体外引流组术后肉眼血尿发生率低于长时间双J管体内引流组（P0.01）、短时间双J管体内引流组（P0.05）。肾造瘘体外引流组术后并发症总发生率低于长时间双J管体内引流组、短时间双J管体内引流组（P0.01）。肾造瘘体外引流组尿路感染发生率低于长时间双J管体内引流组（P0.05）。肾造瘘体外引流组引流管堵塞、大网膜脱出发生率低于短时间双J管体内引流组（P0.05）。吻合口梗阻发生率比较，三组无显著性差异（P0.05）。 ⑤三组术后随访成功率比较，无显著性差异（P0.05）。结论 1腹腔镜肾盂输尿管成形术中CO_2气腹是引起儿童术中高碳酸血症的主要因素，腹腔内残余CO_2是引起术后高碳酸血症的主要因素。 2术毕充分置换腹腔内残余CO_2是降低术后高碳酸血症发生的重要措施。 3年龄越小，CO_2气腹对机体酸碱平衡的影响越大。尤其对于小年龄儿童，加强围手术期监测及麻醉管理，术后促进CO_2充分排空，可降低CO_2导致的高碳酸血症的发生率。 4腹腔镜肾盂输尿管成形术后留置肾造瘘体外引流对患儿机体创伤最小，恢复最快。 5三种引流方式均有其适应症，应根据实际情况选择最适宜的引流方式。
[Abstract]:Objective to analyze the results of blood gas analysis after laparoscopic ureteropelvic angioplasty, and to explore the factors affecting the balance of acid and base in children with CO_2 pneumoperitoneum and its preventive and therapeutic measures. To evaluate the advantages and disadvantages and indications of different drainage methods of urinary pelvis and urine after operation. Methods 1 A total of 64 children with laparoscopic ureteroplasty and 64 children with open ureteroplasty were divided into two groups: laparoscopic group and open group. 26 children with laparoscopic ureteropelvic angioplasty were treated with air replacement of residual CO_2 at the end of the operation. As a laparoscopic intervention group, all children underwent arterial blood gas analysis at 4 hours after operation. The incidence of hypercapnia was compared between the laparoscopic group and the open group, the laparoscopic group and the laparoscopic intervention group. To compare the incidence of acid-base imbalance in children of different age groups. 2 90 children with laparoscopic pyeloplasty were divided into two groups: external drainage group with nephrostomy and double J tube drainage group with long period of time. The difference of postoperative complications and success rate among the three groups was compared. Results 1the incidence of hypercapnia in the laparoscopic group was higher than that in the open group (P 0.05). There was no significant difference in the incidence of metabolic acidosis between the two groups. 2 with the increase of age, the incidence of acid-base imbalance in laparoscopy group and open group decreased gradually. The incidence of acid-base imbalance in laparoscopic group was significantly higher than that in school-age group (P 0.01). The pre-school group was higher than the school-age group (P 0.05), and the infant group was compared with the pre-school group. The incidence of acid-base imbalance in the open group was significantly higher than that in the school-age group (P0.01), and that in the pre-school group was higher than that in the school-age group (P0.05). There was no significant difference between the infant group and the pre-school group (P0.05). 3The incidence of hypercapnia in the laparoscopic intervention group was lower than that in the laparoscopic group (P 0.05), and there was no significant difference between the two groups in the incidence of metabolic acidosis. (4) the incidence of gross hematuria in the external drainage group was lower than that in the double-J tube drainage group for a long time (P 0.01). The incidence of postoperative complications in the external drainage group was lower than that in the long-term double-J tube drainage group. The incidence of urinary tract infection in the external drainage group was lower than that in the long-term double-J tube drainage group. The drainage tube was blocked in the external drainage group. The incidence of greater omentum prolapse was lower than that of the short time double J tube drainage group (P 0.05), and there was no significant difference among the three groups in the incidence of anastomotic obstruction. 5 there was no significant difference in the success rate of postoperative follow-up among the three groups (P 0.05). Conclusion 1 CO_2 pneumoperitoneum was the main cause of hypercapnia in children during laparoscopic pyeloureteroplasty, and residual CO_2 in abdominal cavity was the main cause of postoperative hypercapnia. 2 adequate replacement of intraperitoneal residual CO_2 at the end of operation is an important measure to reduce postoperative hypercapnia. 3 the older the CO-2 pneumoperitoneum, the greater the effect of pneumoperitoneum on the balance of acid and base. Especially for the young children, the perioperative monitoring and anesthesia management should be strengthened to promote the full emptying of CO_2 after operation. It can reduce the incidence of hypercapnia caused by CO_2. 4 Laparoscopic ureteropelvic angioplasty with indwelling nephrostomy external drainage was the least traumatic and the fastest recovery. 5. All the three drainage methods have their indications, and the most suitable drainage methods should be selected according to the actual situation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.9

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