CT引导经皮肾穿刺造瘘联合二期经皮肾镜治疗感染性鹿角形肾结石

发布时间：2018-12-08 19:22

【摘要】：目的：探讨CT引导经皮肾穿刺造瘘联合二期经皮肾镜治疗感染性鹿角形肾结石的有效性及安全性。方法：回顾性分析邵逸夫医院在2011年1月至2013年12月期间收治的30例感染性鹿角形肾结石患者。所有患者均行B超、KUB、CT、尿常规及中段尿培养及术后结石成分分析等明确诊断为感染性鹿角形肾结石。其中12例行CT引导经皮肾穿刺造瘘联合二期经皮肾镜治疗(CT组),18例行术中B超引导经皮肾穿刺一期经皮肾镜治疗(B超组)。比较两组病人在手术时间、术中出血量、总住院费用、术后住院时间、结石清除率及术后并发症等情况上的差异。结果：两组患者在性别、肾积水情况、结石最长径、S.T.O.N.E. Nephrolithometry评分等比较无显著性差异(P0.05),年龄上存在显著性差异(P0.05),CT组平均年龄(61.2±11.7)岁,B超组平均年龄(52.0±11.8)岁。CT组和B超组手术时间分别为(118±15.7)min和(151.9±35.3)mmin,术中出血量分别为(37.1±17.9)ml和(68.9±43.3)ml,总住院费用分别为(31.4±3.8)千元和(28.3±3.6)千元,术后住院时间分别为(4.5±1.2)天和(5.6±1.2)天,一次清石率分别为91.7%(11/12)和83.3%(15/18),术后并发症分别为16.7%(2/12)和33.3%(6/18),均存在统计学意义(P0.05)。结论：相比B超引导经皮肾穿刺一期经皮肾镜碎石术,CT引导经皮肾穿刺造瘘二期经皮肾镜碎石术具有手术时间短,术中出血少、术后恢复快、并发症少、结石一次清除率高等优点,但是总住院费用较B超引导经皮肾穿刺一期经皮肾镜碎石术高。
[Abstract]:Objective: to evaluate the efficacy and safety of CT guided percutaneous nephrostomy combined with two stage percutaneous nephroscopy in the treatment of infectious staghorn nephrolithiasis. Methods: thirty patients with infectious staghorn renal calculi from January 2011 to December 2013 in Shaw Hospital were retrospectively analyzed. All patients were diagnosed as infective staghorn nephrolithiasis by B ultrasound, KUB,CT, urine routine, middle urine culture and postoperative stone composition analysis. Twelve cases were treated with CT guided percutaneous nephrostomy combined with second stage percutaneous nephroscopy (CT group), and 18 cases were treated by B-ultrasound guided percutaneous nephrolithotomy (B-ultrasound group). The differences of operation time, intraoperative bleeding volume, total hospitalization cost, postoperative hospitalization time, stone clearance rate and postoperative complications were compared between the two groups. Results: there was no significant difference in sex, hydronephrosis, the longest diameter of stone, S.T.O.N.E. Nephrolithometry score between the two groups (P0.05), but there was significant difference in age (P0.05). The mean age of CT group was (61.2 卤11.7) years, and that of B-ultrasound group was (52.0 卤11.8) years. The operative time of CT group and B-ultrasound group were (118 卤15.7) min and (151.9 卤35.3) mmin, respectively. The total hospitalization expenses of (37.1 卤17.9) ml and (68.9 卤43.3) ml, were (31.4 卤3.8) thousand yuan and (28.3 卤3.6) thousand yuan, respectively. The duration of hospitalization was (4.5 卤1.2) days and (5.6 卤1.2) days, respectively. The stone removal rates were 91.7% (11 / 12) and 83.3% (15 / 18), respectively. Postoperative complications were 16. 7% (2 / 12) and 33. 3% (6 / 18), respectively, which were statistically significant (P0.05). Conclusion: compared with B-ultrasound guided percutaneous nephrolithotripsy, CT guided percutaneous nephrolithotripsy has shorter operation time, less intraoperative bleeding, faster recovery and fewer complications. The cost of total hospitalization was higher than that of percutaneous nephrolithotripsy guided by B-ultrasound in one stage percutaneous nephrolithotripsy.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699

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