等离子柱状电极在部分无管化PCNL术中的应用研究

发布时间：2018-01-18 11:12

本文关键词：等离子柱状电极在部分无管化PCNL术中的应用研究　出处：《蚌埠医学院》2016年硕士论文　论文类型：学位论文

【摘要】：背景和目的经皮肾镜取石术是目前治疗肾结石重要的手术方式之一,通过肾穿刺造瘘通道完成碎石取石操作,对患者的创伤较小,目前已基本取代传统开放手术。经过40年的发展,采用无管化的处理方式,即术后不留置肾造瘘管,是经皮肾镜碎石术重要的发展趋势。但术中术后的出血是影响无管化成功率的关键因素。对于经皮肾穿刺通道的止血,至今没有一种切实有效的方法。我们在总结前辈们经验的基础上,将等离子止血技术应用于经皮肾穿刺通道的止血处理中,并将结果与接受传统经皮肾镜取石术的病例进行对比研究,以期证明等离子柱状电极在处理经皮肾穿刺通道出血的有效性和安全性。方法从2013年12月至2015年9月所有上尿路结石患者中,按照既定标准选取40例并随机分为两组,20例接受采用等离子电凝止血的无管化经皮肾镜取石术(无管化组),另外20例行传统的经皮肾镜取石术(传统组)。应用统计学方法对两组的手术时间、发热情况、可视化疼痛评分、镇痛药物使用率、Hb和HCT下降程度、胃肠功能恢复时间、术后住院时间和费用、肾周血肿和积液发生率进行对比分析。结果所有40例患者均一期碎石成功,未出现周围脏器损伤,无中转开放病例。无管化组和传统组在手术时间、清石率,术后发热率、术后胃肠道功能恢复时间,肾周血肿和积液发生率方面,并无统计学差异。而在术后Hb和HCT下降幅度、术后第一天VAS评分、镇痛药物使用率、术后住院时间和费用方面,无管化组均低于传统组,且差异具有统计学意义。结论应用等离子柱状电极对PCNL工作通道经行止血,是一种安全有效的主动止血方式,狭小通道中使用简便、易行,对正常组织热损伤小,可有效减少术后出血,术后不留置肾造瘘管,与传统PCNL术相比,不增加术后并发症的同时有利于患者恢复,术后疼痛明显降低,缩短住院时间,节约住院费用。
[Abstract]:Background and objective Percutaneous nephrolithotomy is one of the most important methods in the treatment of renal calculi. At present, the traditional open surgery has been basically replaced. After 40 years of development, the management without tube, that is, no indwelling renal fistula tube after operation. It is an important development trend of percutaneous nephrolithotripsy, but the bleeding after operation is the key factor to influence the success rate of unmanaged nephrolithotripsy. So far there is no effective method. Based on the experience of our predecessors, plasma hemostasis technology has been applied to the hemostatic treatment of percutaneous renal puncture passage. The results were compared with those of traditional percutaneous nephrolithotomy. To prove the effectiveness and safety of plasma columnar electrode in the treatment of percutaneous renal hemorrhage. Methods from December 2013 to September 2015, all patients with upper urinary calculi were treated. According to the established criteria, 40 cases were randomly divided into two groups, 20 cases received plasma electrocoagulation hemostatic percutaneous nephrolithotomy (no tube group). The other 20 patients were treated with traditional percutaneous nephrolithotomy (traditional group). The time of operation, fever, visual pain score, the usage rate of analgesic drugs and the degree of decrease of HB and HCT were measured by statistical method. The recovery time of gastrointestinal function, postoperative hospitalization time and cost, the incidence of perirenal hematoma and hydrops were compared and analyzed. Results all 40 patients were successfully treated with primary lithotripsy without peripheral organ injury. In the control group and the traditional group, the time of operation, the rate of stone removal, the rate of postoperative fever, the recovery time of postoperative gastrointestinal function, the incidence of perirenal hematoma and hydrops were analyzed. There was no significant difference between the two groups. However, the decrease of HB and HCT, the VAS score on the first day after operation, the utilization rate of analgesic drugs, the postoperative hospitalization time and the cost were lower in the unmanaged group than in the traditional group. The difference is statistically significant. Conclusion Plasma columnar electrode is a safe and effective way to stop bleeding in PCNL working channel. It is simple and easy to use in narrow channel. Heat injury to normal tissue is small, can effectively reduce postoperative bleeding, no indwelling renal fistula tube, compared with the traditional PCNL surgery, no increase in postoperative complications at the same time is conducive to recovery, postoperative pain significantly reduced. Shorten the time of hospitalization and save the cost of hospitalization.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R699.2

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