经皮肾镜取石术治疗复杂性肾结石疗效与通道选择的关系研究

发布时间：2018-04-21 08:45

本文选题：经皮肾镜取石术 + 复杂性肾结石　；参考：《泸州医学院》2014年硕士论文

【摘要】：目的：通过对比不同通道选择情况下行经皮肾镜取石术(Percutaneousnephrolithotomy, PCNL)治疗复杂性肾结石的安全性及治疗效果，为复杂性肾结石治疗方案的选择提供理论依据。方法：自2011年7月开始，将泸州医学院附属宜宾市第一人民医院泌尿外科收治的肾结石患者按设计的入选标准和排除标准进行筛查并签署知情同意书，对获得的病例按入选时间的先后顺序编号，按编号依次归入标准通道组、微通道组、双微通道组。所有患者均行经皮肾镜取石术，实验进行至2012年7月，共获得病例126例，每组病例数为42例。其中标准通道组患者年龄(47.9±12.6)岁；微通道组年龄(50.3±13.6)岁；双微通道组年龄(48.2±14.4)岁。标准通道组结石大小(4.16±1.18)cm；微通道组结石大小(4.45±1.26)cm；双微通道组结石大小(4.29±1.26)cm。所有患者均在彩超引导下进行PCNL，将三组患者的手术时间、结石清除率、术后住院时间进行对比，，比较各组治疗效果的差异；将三组患者术中及术后并发症发生率、出血量进行对比，比较各组安全性的差异。结果：126例患者均顺利完成手术，并发症发生率分别是标准通道组14.29%、微通道组9.52%、双微通道组9.52%。微通道组与双微通道组并发症率相同，将这两组与标准通道组比较，经过2检验（2=0.454，P=0.736），差异无统计学意义(P0.05)。术后结石清除率：标准通道组69.05%，微通道组66.67%，双微通道组88.10%。标准通道组与微通道组间结石清除率比较，经χ2检验（χ2=0.055，P=0.815）,差异无统计学意义(P0.05)；标准通道组与双微通道组间结石清除率比较，经χ2检验（χ2=4.525，P=0.033）,差异有统计学意义(P0.05)；微通道组与双微通道组间结石清除率比较，经χ2检验（χ2=5.509，P=0.019）,差异有统计学意义(P0.05)。对于结石长径大于等于5cm的病例，标准通道组结石清除率为33.33%，微通道组结石清除率为30.77%，双微通道组结石清除率为75%，标准通道组与微通道组间结石清除率比较，经χ2检验（χ2=0.012，P=0.851）,差异无统计学意义(P0.05)。标准通道组与双微通道组间结石清除率比较，经χ2检验（χ2=5.239，P=0.022）,差异有统计学意义(P0.05)。微准通道组与双微通道组间结石清除率比较，经χ2检验（χ2=3.576，P=0.027）,差异有统计学意义(P0.05)。手术时间比较：标准通道组(67.98±27.61)分钟；微通道组(69.76±24.79)分钟；双微通道组(61.79±21.21)分钟。三组患者手术时间两两配对经t检验，差别均无统计学意义(P0.05)。术中出血量比较：标准通道组(70.71±40.18)ml；微通道组(78.71±36.51)ml；双微通道组(79.69±40.84)ml。三组患者术中出血量两两配对经t检验，差别均无统计学意义(P0.05)。术后住院时间:标准通道组(8.45±2.66)天；微通道组(8.33±3.06)天；双微通道组(8.00±1.93)天，三组患者术中术后住院时间两两配对经t检验，差别均无统计学意义(P0.05)。结论：标准通道、微通道、双微通道PCNL治疗复杂性肾结石在手术时间、术中出血量、并发症率及术后住院时间这几项指标中无明显差别。一期单通道PCNL治疗复杂性肾铸型结石术后残石率较双微通道高，往往需要二期手术。双微通道治疗复杂性肾结石能明显提高结石清除率，出血量及术后并发症并没有增加，可作为复杂性结石、特别是结石长径大于等于5cm的全铸型结石的首选治疗方式。
[Abstract]:Objective : To study the safety and therapeutic effects of percutaneous nephrolithotripsy ( PCNL ) in the treatment of complicated renal calculus by contrast of different channel selection . Methods : From July 2011 , the patients with renal calculus treated by urological surgery in the First People ' s Hospital of the City of Luzhou Medical College were screened and signed the informed consent form . All patients were enrolled in the standard channel group , the micro - channel group and the double - micro - channel group according to the selection criteria and exclusion criteria .
Age of micro channel group ( 50.3 卤 13.6 ) years ;
The age ( 48.2 卤 14.4 ) years in the dual microchannel group . The size of the standard channel group was ( 4.16 卤 1.18 ) cm .
Microchannel group stone size ( 4.45 卤 1.26 ) cm ;
The size of the stones ( 4.29 卤 1.26 ) cm in the double micro - channel group was 4.29 卤 1.26 cm . All patients were treated with PCNL under the guidance of color Doppler ultrasound . The operative time , stone clearance rate and hospitalization time of the three groups were compared , and the difference of treatment effect was compared .
Results : The incidence of postoperative complications was 14.29 % in the standard channel group , 9.52 % in the micro - channel group and 9.52 % in the double - micro - channel group . The rate of postoperative stone clearance was 69.05 % in the standard channel group , 66.67 % in the micro - channel group and 88.10 % in the double - micro - channel group .
The rate of stone clearance between the standard channel group and the double micro - channel group was significantly higher than that of the double micro - channel group ( 蠂2 = 4.525 , P = 0.033 ) , and the difference was statistically significant ( P0.05 ) .
The rate of stone clearance in the standard channel group was 33.33 % , the rate of stone clearance in the micro - channel group was 33.33 % , the stone clearance rate in the micro - channel group was 33.33 % , the stone clearance rate in the micro - channel group was 30.77 % , the rate of stone clearance between the standard channel group and the micro - channel group was 75 % , the difference was significant ( P0.05 ) .
Microchannel group ( 69.76 卤 24.79 ) minutes ;
There was no significant difference in the operative time between the two groups ( 61.79 卤 21.21 ) minutes . There was no statistical difference between the two groups ( P0.05 ) .
Microchannel group ( 78.71 卤 36.51 ) ml ;
There was no significant difference between the two groups ( 79.69 卤 40.84 ) ml in the two groups ( 79.69 卤 40.84 ) ml . There was no significant difference between the two groups ( P0.05 ) .
Microchannel group ( 8.33 卤 3.06 ) days ;
Conclusion : The standard channel , micro - channel and double micro - channel PCNL have no significant difference in the operative time , the bleeding volume , the complication rate and the time of hospitalization . Conclusion : The single - channel PCNL in the treatment of complicated renal calculi has a higher residual stone rate than the double micro - channel .

【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2

【参考文献】