配备专业凸阵穿刺探头的超声引导经皮肾穿刺建立工作通道在PCNL手术中的临床应用研究

发布时间：2018-04-19 10:59

本文选题：PCNL + 超声　；参考：《广西医科大学》2016年硕士论文

【摘要】：目的：评价配备专业凸阵穿刺探头的B超引导经皮肾穿刺建立工作通道在PCNL手术中的临床价值。方法：选取2014年1月至2015年1月在广西医科大学第一附属医院泌尿外科行PCNL手术(采用专业凸阵穿刺B超探头引导建立工作通道)的病例177例,其中男112例,女65例,年龄15-71岁,平均44±14.21岁。统计每例患者手术通道建立时间、肾盏入路、手术时间、术中出血量、并发症、结石清除率、术后住院时间,作为实验组。另外,收集2010年1月至2012年1月在广西医科大学第一附属医院泌尿外科行PCNL手术(采用普通B超探头或X线引导建立工作通道)的病例152例作为对照组进行比较分析。其中男95例,女57例,年龄13-78岁,平均46±12.77岁。结果：所用患者均完成通道建立及PCNL过程。实验组肾通道建立时间10.36±2.54min,上盏穿刺84例(47.5%),中盏穿刺72例(40.7%),下盏穿刺21例(11.9%),双通道7例(3.9%),三通道4例(2.6%)。手术时间41-177分钟,平均70.61±20.23分钟,术中失血5-200ml,平均41.76±31.97ml,术后平均住院5.75±2.09天。清石率88.14%(156/177),其中2例患者出现气胸,给予对症治疗后好转,无需胸腔闭式引流,6例患者术后感染发热；术后出血8例,其中7例保守治疗好转,1例行动脉栓塞治疗好转。因术中大出血转开放手术病例1例。对照组肾通道建立时间15.08±3.18min,上盏穿刺55例(36.2%),中盏穿刺73例(48.0%),下盏穿刺24例(15.8%),双通道9例(5.9%),三个通道4例(2.6%)。手术时间45-120分钟,平均81.13±19.71分钟,术中失血5～200ml,平均67.76±39.66ml,术后平均住院6.19±2.46天。清石率80.26%(122/152),其中1例患者出现气胸,给予对症治疗后好转,无需胸腔闭式引流,1例患者术中输尿管连接部粘膜撕裂,保守治疗好转。6例患者术后感染发热；术后出血8例,保守治疗好转。无术中出血转开放手术病例。经统计学分析,结果显示两组患者在手术通道建立时间、肾盏入路、手术时间、结石清除率、术后住院时间上有显著性差异(P0.05),而并发症的发生率无统计学意义。结论：配备专业凸阵穿刺探头的B超能够安全、有效地引导经皮肾穿刺,建立工作通道,在PCNL治疗中有很好的临床应用价值。
[Abstract]:Objective: to evaluate the clinical value of B-ultrasound guided percutaneous renal puncture in PCNL operation.Methods: from January 2014 to January 2015, 177 patients (112 males and 65 females) underwent PCNL operation in Urology Department, the first affiliated Hospital of Guangxi Medical University.The average age was 44 卤14.21 years old.The time of establishing operation passage, the time of operation, the amount of intraoperative bleeding, the complications, the rate of stone clearance, the time of hospitalization after operation were counted as the experimental group.In addition, from January 2010 to January 2012, 152 patients who underwent PCNL operation in the Urology Department of the first affiliated Hospital of Guangxi Medical University (using common B-ultrasound probe or X-ray guidance to establish the working channel) were compared and analyzed as the control group.There were 95 males and 57 females, aged 13 to 78 years, with an average age of 46 卤12.77 years.Results: all the patients completed the process of channel establishment and PCNL.In the experimental group, the time of establishing renal passage was 10.36 卤2.54 min, the upper calyceal puncture was 47.5 minutes, the middle calyceal puncture was 40.7m, the inferior calyceal puncture was 11.9T, the double channel was 3.9T, and the three-channel was 2.6C.The operative time was 41-177 minutes (mean 70.61 卤20.23 minutes), the blood loss during operation was 5-200 ml (mean 41.76 卤31.97 ml), and the average hospital stay was 5.75 卤2.09 days.The rate of clearing stone was 88.14% of 156 / 177, of which 2 cases had pneumothorax, 6 cases had fever and infection without chest closed drainage, and 8 cases had postoperative hemorrhage, among which 7 cases were improved by conservative treatment and 1 case by arterial embolization.One case was converted to open operation due to massive intraoperative hemorrhage.In the control group, the time of establishing renal passage was 15.08 卤3.18 min, that of upper calyceal puncture was 36.2 minutes, that of middle calyceal puncture was 48.0, that of lower calyceal puncture was 15.8, that of double channel was 5.9 and that of three channels was 2.6.The operative time was 45-120 minutes (mean 81.13 卤19.71 minutes), and the blood loss during operation was 57.76 卤39.66 ml, and the average hospital stay was 6.19 卤2.46 days.The stone clearance rate was 80.26 / 122 / 152, in which one patient developed pneumothorax, improved after symptomatic treatment, 1 patient did not need closed thoracic drainage, 1 patient underwent intraoperative ureteral junction mucosal tear, 6 patients received conservative treatment, 6 patients became infected and febrile after operation, 8 patients suffered from postoperative haemorrhage.Conservative treatment improved.No intraoperative bleeding was converted to open operation.The results of statistical analysis showed that there were significant differences between the two groups in the time of establishing operation channel, renal calyceal approach, operation time, stone clearance rate and postoperative hospitalization time (P 0.05), but the incidence of complications was not statistically significant.Conclusion: B-ultrasound equipped with professional convex array puncture probe can guide percutaneous renal puncture effectively and establish working channel. It has good clinical application value in the treatment of PCNL.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R699

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