CT尿路成像指导准确定位PCNL目标肾盏的临床研究

发布时间：2018-07-02 23:51

本文选题：经皮肾镜取石术 + CT尿路成像　；参考：《昆明医科大学》2013年硕士论文

【摘要】：[目的]：探讨CT尿路成像在指导准确定位PCNL目标肾盏的应用价值,并得应用于术中对PCNL在处理肾结石的临床价值。 [方法]：在2011年7月—2013年3月期间,选择在昆明医科大学第二附属医院微创泌尿外科确诊为肾结石并需行PCNL治疗的150例患者,其中男性121例,女性29例。年龄最大的为71岁,最小的为21岁。全部患者均经影像学依据诊断为肾结石,同时满足纳入和排除的标准。然后随机分成CT尿路成像组75例与不行CT尿路成像组的75例。全部患者均在常规全麻下行PCNL治疗。研究组根据CTU影响学资料定位的肾盏穿刺目标肾盏。记录两组患者术前的一般资料,包括年龄、体重、身高、复杂性肾结石、结石大小和病程时间等情况。获取研究组和对照组每一名患者的手术时间、术后一期结石清除率即无石率、术后住院天数和出血输血情况。将所得数据指标进行统计学分析处理。 [结果]：统计学分析表明：研究组和对照组患者术前的结石大小、病程时间、患者年龄、BMI指数和功能性独肾患者数均无统计学差异。149患者的手术均顺利完成,对照组有1例患者术中穿刺扩张后出血较多,留置肾造瘘管压迫止血好转后改二期手术。术后均无出现丢肾或患者死亡的情况。研究组与对照组在接受PCNL治疗肾结石的无石率分别为：64/75(83.5%)和54/75(72%)；其中复杂性肾结石患者达到无石率人数为：20(68.96%)和11(45.83%)；术后输血人数为0人和4人；术后血红蛋白下降较术前大于30%的人数为2人和9人；手术时间分别为：83.08±28.04min和92.94±28.50min,以上数据统计学分析显示有统计学差异(P0.05)。研究组和对照术后平均住院天数为6.64±2.66和7.00±2.73：术中严重出血的人数为0人和1人；术后持续超过24h肾瘘管引流液较红或严重血尿人数分别为3人和9人,均无统计学意义(P0.05)。 [结论]：CT尿路成像可清晰的了解肾盂肾盏和结石的解剖形态及其二者之间的关系,对拟行PCNL治疗的肾结石患者,可以达到准确的定位最佳的目标肾盏,对术中在C臂X线监视下,对穿刺和建立通道有指导意义。CT尿路成像通过指导选择最佳目标肾盏,并对穿刺目标肾盏和建立通道有指导意义,从而可以提高结石清除率、减少术后输血率和减少手术时间,减少术后出血相关并发症,提高PCNL治疗肾结石的疗效,值得在临床上推广应用。
[Abstract]:[Objective] to explore the application value of CT urogram in guiding accurate location of PCNL target calyx, and to be applied to the clinical value of PCNL in the treatment of renal calculi.
[method]: from July 2011 to March 2013, 150 patients with renal calculi and PCNL treatment were selected at the Second Affiliated Hospital of the Second Affiliated Hospital of Kunming Medical University, including 121 males and 29 females. The oldest was 71 years old and the smallest was 21 years old. All patients were diagnosed as kidney stones by imaging basis, and satisfied at the same time. The criteria for inclusion and exclusion were randomly divided into 75 patients in the CT urological group and 75 in the non CT urological group. All the patients were treated with PCNL under general anesthesia. The study group was based on the target renal calycalycacal calyx based on the CTU data. The general data of two groups of patients were recorded, including age, weight, height, and complex renal calculi. The operation time of each patient in the study group and the control group was obtained, the stone clearance rate was no stone rate, the number of days after the operation and the condition of blood transfusion after the operation. The data were analyzed statistically.
[results]: statistical analysis showed that the size, course time, age of the patients, BMI index and the number of functional independent kidney patients in the study group and the control group were all without significant difference in the operation of.149 patients. There were 1 cases in the control group with more bleeding after the puncture, and the improvement of the renal fistulae compression hemostasis after the improvement of the patients in the control group. The two stage operation was changed. No kidney loss or death was found after operation. The rate of stone free treatment in the study group and the control group was 64/75 (83.5%) and 54/75 (72%), and the number of patients with complex renal calculi was 20 (68.96%) and 11 (45.83%); the number of blood transfusions after operation was 0 and 4; blood red eggs after operation. The number of white drops was 2 and 9 people more than 30% before operation; the operation time was 83.08 + 28.04min and 92.94 + 28.50min, and the statistical analysis showed that there were statistical differences (P0.05). The average days of hospitalization were 6.64 + 2.66 and 7 + 2.73 in the study group and the control operation. The number of severe bleeding in the operation was 0 and 1. There were no statistically significant differences in the number of renal draining fluid than those of red or severe hematuria in 24h patients (P0.05). There were no significant differences between the 3 groups (9).
[conclusion]:CT urography can clearly understand the anatomy of the renal pyelolithiasis and stones and the relationship between them and the relationship between the two. The best target renal calyx can be accurately positioned for patients with renal calculi with PCNL treatment. Under the monitoring of C arm X-ray, the best choice of.CT urography is to guide the choice of the best. The good target kidney calycalyst is of guiding significance to the puncture target renal calyx and the establishment of the channel, which can improve the stone clearance rate, reduce the postoperative blood transfusion rate, reduce the operation time, reduce the postoperative bleeding related complications and improve the therapeutic effect of PCNL in the treatment of kidney stones. It is worthy of clinical application.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R699.2;R816.7

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