CT模拟不同体位经皮肾镜取石术穿刺路径及体内脏器变化对比研究
发布时间：2018-11-21 07:31
【摘要】：目的:通过CT影像学检查观察不同体位情况下PCN穿刺路径以及肾脏、周围脏器和组织的变化情况,为不同体位PCNL通道建立的的安全性提供科学依据。方法:选择在我院准备接受经皮肾镜治疗的肾结石患者40人,根据患肾部位的左右分为A、B两组,每组各20人,两组病人均在术前以斜仰卧位、侧卧位及俯卧位三种体位行CTU扫描检查,各体位通过CT影像数据均分别测量肾脏上、中、下盏后组的三个观察指标:最短经皮肾盏穿刺距离、穿刺路径皮下脂肪厚度、最大可穿刺范围角度以及肾脏的腋后线切面无覆盖区长度比,利用配对设计的秩和检验进行统计学分析。结果:最短经皮肾盏穿刺通道长度:俯卧位下穿刺通道均值最短,斜仰卧次之,其中(左右两侧的上、中盏侧卧位对比俯卧位,右上盏组斜仰卧位对比俯卧位)对比有统计学差别(P0.05),余组别对比均无统计学意义(P0.05);皮下脂肪厚度:斜仰卧位下脂肪厚度均值除左上盏组低于俯卧位外,余均在三组体位中距离最长,俯卧位与侧卧位对比不明显,其中(左中、右上、中盏组斜仰卧位对比俯卧位,左下、右上、中、下盏组斜仰卧位对比侧卧位)具有统计学意义(P0.05),余组别对比均无统计学意义(P0.05);最大穿刺角度:俯卧位下肾脏中、下盏可穿刺角度最小,斜仰卧位次之,其中(左中盏、右下盏组斜仰卧位对比俯卧位,左中、下盏及右中、下盏组侧卧位对比俯卧位)具有统计学意义(P0.05),余组别对比均无统计学意义(P0.05);腋后线切面无覆盖区长度比值:斜仰卧位比值最大,俯卧位次之,对比均无统计学意义(P0.05)。结论:在经皮肾镜手术中,采取俯卧位手术,对比斜仰卧位及侧卧位,其穿刺路径更短;患者在术中采取斜仰卧其术区脂肪厚度要大于其他两种体位;侧卧位及斜仰卧位比较俯卧位可明显增加肾脏中、下盏最大穿刺角度。
[Abstract]:Objective: to observe the changes of PCN puncture pathway, kidney, peripheral organs and tissues in different postures by CT imaging examination, so as to provide scientific basis for the safety of PCNL channels in different postures. Methods: forty patients with renal calculi who were undergoing percutaneous nephroscopy in our hospital were divided into two groups according to the left and right side of the affected kidney, 20 patients in each group. The patients in the two groups were all in oblique supine position before operation. CTU scanning was performed in the lateral position and prone position. The three indexes of renal upper, middle and lower calyceal posterior group were measured by CT image data: the shortest distance of percutaneous renal calyceal puncture, the thickness of subcutaneous fat in the puncture path. The angle of the maximum puncture range and the ratio of the length of the uncovered area on the posterior axillary section of the kidney were analyzed statistically by using the rank sum test designed by pairing design. Results: the shortest length of percutaneous renal calyceal puncture passage was the shortest in prone position, followed by oblique supine position. In the right upper calyx group, there was statistical difference between the oblique supine position and the prone position (P0.05), but there was no significant difference in the other groups (P0.05). Subcutaneous fat thickness: the mean of fat thickness in oblique supine position except left superior calyx group was lower than that in prone position, the rest was the longest in the three groups, the contrast between prone position and lateral position was not obvious, among them (left middle, right upper, right upper), In the calyceal group, there was statistical significance in the oblique supine position compared with the prone position, in the lower left, right upper, middle and lower calyx groups in the oblique supine position compared with the lateral supine position (P0.05), but there was no statistical significance in the remaining group (P0.05). Maximum puncture angle: in the prone position, the lower calyceal puncture angle was the smallest, and the oblique supine position was the second, among which (left middle calyx, right lower calyx group, oblique supine position compared with prone position, left middle, lower calyx and right middle), The lateral position of the lower calyx group compared with the prone position) had statistical significance (P0.05), while the contrast of the other groups had no statistical significance (P0.05). The ratio of the length of no covering area in the posterior axillary line section: the ratio of oblique supine position was the largest, the prone position was the second, the contrast had no statistical significance (P0.05). Conclusion: in percutaneous nephroscopic surgery, the puncture path of prone position is shorter than that of oblique supine position and lateral position, and the fat thickness of the operation area in oblique supine position is larger than that in the other two positions. The lateral position and oblique supine position significantly increased the maximum puncture angle of the lower calyx in the kidney than in the prone position.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.2
本文编号：2346319
[Abstract]:Objective: to observe the changes of PCN puncture pathway, kidney, peripheral organs and tissues in different postures by CT imaging examination, so as to provide scientific basis for the safety of PCNL channels in different postures. Methods: forty patients with renal calculi who were undergoing percutaneous nephroscopy in our hospital were divided into two groups according to the left and right side of the affected kidney, 20 patients in each group. The patients in the two groups were all in oblique supine position before operation. CTU scanning was performed in the lateral position and prone position. The three indexes of renal upper, middle and lower calyceal posterior group were measured by CT image data: the shortest distance of percutaneous renal calyceal puncture, the thickness of subcutaneous fat in the puncture path. The angle of the maximum puncture range and the ratio of the length of the uncovered area on the posterior axillary section of the kidney were analyzed statistically by using the rank sum test designed by pairing design. Results: the shortest length of percutaneous renal calyceal puncture passage was the shortest in prone position, followed by oblique supine position. In the right upper calyx group, there was statistical difference between the oblique supine position and the prone position (P0.05), but there was no significant difference in the other groups (P0.05). Subcutaneous fat thickness: the mean of fat thickness in oblique supine position except left superior calyx group was lower than that in prone position, the rest was the longest in the three groups, the contrast between prone position and lateral position was not obvious, among them (left middle, right upper, right upper), In the calyceal group, there was statistical significance in the oblique supine position compared with the prone position, in the lower left, right upper, middle and lower calyx groups in the oblique supine position compared with the lateral supine position (P0.05), but there was no statistical significance in the remaining group (P0.05). Maximum puncture angle: in the prone position, the lower calyceal puncture angle was the smallest, and the oblique supine position was the second, among which (left middle calyx, right lower calyx group, oblique supine position compared with prone position, left middle, lower calyx and right middle), The lateral position of the lower calyx group compared with the prone position) had statistical significance (P0.05), while the contrast of the other groups had no statistical significance (P0.05). The ratio of the length of no covering area in the posterior axillary line section: the ratio of oblique supine position was the largest, the prone position was the second, the contrast had no statistical significance (P0.05). Conclusion: in percutaneous nephroscopic surgery, the puncture path of prone position is shorter than that of oblique supine position and lateral position, and the fat thickness of the operation area in oblique supine position is larger than that in the other two positions. The lateral position and oblique supine position significantly increased the maximum puncture angle of the lower calyx in the kidney than in the prone position.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.2
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