术中B超在MPCNL治疗鹿角形肾结石中的应用

发布时间：2019-05-22 16:40

【摘要】：目的：探讨术中B超在MPCNL治疗鹿角形肾结石中的应用方法及技巧,观察其临床效果。 方法：选择2013年1月至2014年3月期间,在昆明医科大学第二附属医院泌尿外科二病区行MPCNL治疗的60例鹿角形肾结石成人患者,均采用B超引导穿刺建立通道和钬激光碎石。对照组30例(34侧结石)：B超引导穿刺建立1-2个通道取石,术中在输尿管镜直视下查找结石并检查各个肾盏,至镜下未见结石后结束手术。实验组30例(35侧结石)：结合术前KUB、IVU和CT设计通道,先用B超引导建立最佳通道(能够最大程度取石的通道)取石,术中应用B超从肾脏各个切面扫描,引导肾盂内结石清除并定位残余结石具体位置,引导输尿管镜查找结石,对于平行盏或盏颈狭窄等无法进入的肾盏内结石,再利用B超定位建立通道取石,最后经B超反复扫描各个肾盏,确认无结石后,结束手术。将两组一期的结石取净率、手术时间、术中出血量、并发症发生率、术后住院时间、手术及术后住院费用等指标进行对比分析。 结果：一期手术结石取净率：对照组22/34(64.7%),实验组32/35(91.4%),P0.05。手术时间：对照组102.75±24.63min,实验组83.43±21.06min, P0.05。术中出血.量：对照组120.13±46.32ml,实验组65.73±22.75ml,P0.05.术后感染：对照组8侧(23.5%),实验组3例(8.57%),P0.05；输血例数：对照组5侧(14.7%),实验组无,P0.05；脏器损伤：对照组无(0%),实验组有一例损伤胸膜(2.86%),P0.05。术后住院时间：对照组9.5+2.75天,实验组5.85±1.37天,P0.05。手术及术后费用：对照组22645.27±8101.4元,实验组12708.64±3437.38元,P0.05。 结论：MPCNL治疗鹿角形结石中,术中系统化的应用B超能够提高一期结石取净率,手术时间、手术并发症、住院时间及费用并不多于非系统化使用B超的对照组。
[Abstract]:Objective: to explore the application method and technique of intraoperative B-ultrasound in the treatment of staghorn kidney stones with MPCNL, and to observe its clinical effect. Methods: from January 2013 to March 2014, 60 adult patients with staghorn kidney stones were treated with MPCNL in the Department of Urology, the second affiliated Hospital of Kunming Medical University. In the control group, 30 cases (34 sides of stones) were treated with B-ultrasound guided puncture. The stones were found under the direct vision of ureter and each renal calyx was examined during the operation, and the operation was completed after no stones were found under the microscope. 30 cases (35 sides of stones) in the experimental group: combined with KUB,IVU and CT before operation, the best channel (the channel that could take the stone to the greatest extent) was established under the guidance of B-ultrasound, and the B-ultrasound was used to scan the various sections of the kidney during the operation. Guide the removal and location of residual stones in the renal pelvis, guide the ureter mirror to find the stones, for parallel calyceal or calyceal neck stenosis and other inaccessible renal calyceal stones, and then use B-ultrasound localization to establish a channel for stone extraction. Finally, each calyx was scanned repeatedly by B-ultrasound, and the operation was completed after confirming that there were no stones. The stone removal rate, operation time, intraoperative bleeding volume, incidence of complications, postoperative hospitalization time, operation and postoperative hospitalization expenses were compared and analyzed between the two groups. Results: the stone removal rate of the first stage operation was 22 鈮，

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