本文關(guān)鍵詞： 腹腔鏡 腎盂輸尿管成形術(shù) 酸堿平衡 引流　出處：《重慶醫(yī)科大學(xué)》2012年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的分析腹腔鏡腎盂輸尿管成形術(shù)后機(jī)體血?dú)夥治鰴z測(cè)結(jié)果，探討CO_2氣腹對(duì)兒童機(jī)體酸堿平衡的影響因素及其防治措施；評(píng)價(jià)術(shù)后腎盂尿液不同引流方式的優(yōu)缺點(diǎn)及適應(yīng)癥。 方法①選擇腹腔鏡及開(kāi)放式腎盂輸尿管成形術(shù)各64例患兒，分為腹腔鏡組和開(kāi)放組。按年齡分別分為嬰幼兒組、學(xué)齡前組和學(xué)齡組。另選擇腹腔鏡腎盂輸尿管成形術(shù)26例患兒，在手術(shù)結(jié)束時(shí)，采取用空氣完全置換腹腔殘余CO_2措施，作為腹腔鏡干預(yù)組。所有患兒均于術(shù)后4小時(shí)行動(dòng)脈血?dú)夥治鰴z測(cè)。比較腹腔鏡組和開(kāi)放組、腹腔鏡組和腹腔鏡干預(yù)組術(shù)后高碳酸血癥發(fā)生率差異；比較不同年齡段患兒術(shù)后酸堿失衡發(fā)生率差異。②選擇腹腔鏡腎盂輸尿管成形術(shù)90例患兒，分為腎造瘺體外引流組、長(zhǎng)時(shí)間雙J管體內(nèi)引流組、短時(shí)間雙J管體內(nèi)引流組。比較三組術(shù)后并發(fā)癥及術(shù)后成功率的差異。 結(jié)果 ①腹腔鏡組術(shù)后高碳酸血癥發(fā)生率高于開(kāi)放組（P0.05），兩組代謝性酸中毒發(fā)生率比較，無(wú)顯著性差異（P0.05）。 ②隨著年齡的增長(zhǎng)，腹腔鏡組與開(kāi)放組術(shù)后酸堿失衡發(fā)生率均呈逐漸下降的趨勢(shì)。腹腔鏡組酸堿失衡發(fā)生率：嬰幼兒組明顯高于學(xué)齡期組（P0.01），學(xué)齡前期組高于學(xué)齡期組（P0.05），嬰幼兒組與學(xué)齡前期組比較，無(wú)顯著性差異（P0.05）。開(kāi)放組酸堿失衡發(fā)生率：嬰幼兒組明顯高于學(xué)齡期組（P0.01），學(xué)齡前期組高于學(xué)齡期組（P0.05），嬰幼兒組與學(xué)齡前期組比較，無(wú)顯著性差異（P0.05） ③腹腔鏡干預(yù)組術(shù)后高碳酸血癥發(fā)生率低于腹腔鏡組（P0.05），兩組代謝性酸中毒發(fā)生率比較，，無(wú)顯著性差異（P0.05）。 ④腎造瘺體外引流組術(shù)后肉眼血尿發(fā)生率低于長(zhǎng)時(shí)間雙J管體內(nèi)引流組（P0.01）、短時(shí)間雙J管體內(nèi)引流組（P0.05）。腎造瘺體外引流組術(shù)后并發(fā)癥總發(fā)生率低于長(zhǎng)時(shí)間雙J管體內(nèi)引流組、短時(shí)間雙J管體內(nèi)引流組（P0.01）。腎造瘺體外引流組尿路感染發(fā)生率低于長(zhǎng)時(shí)間雙J管體內(nèi)引流組（P0.05）。腎造瘺體外引流組引流管堵塞、大網(wǎng)膜脫出發(fā)生率低于短時(shí)間雙J管體內(nèi)引流組（P0.05）。吻合口梗阻發(fā)生率比較，三組無(wú)顯著性差異（P0.05）。 ⑤三組術(shù)后隨訪成功率比較，無(wú)顯著性差異（P0.05）。 結(jié)論 1腹腔鏡腎盂輸尿管成形術(shù)中CO_2氣腹是引起兒童術(shù)中高碳酸血癥的主要因素，腹腔內(nèi)殘余CO_2是引起術(shù)后高碳酸血癥的主要因素。 2術(shù)畢充分置換腹腔內(nèi)殘余CO_2是降低術(shù)后高碳酸血癥發(fā)生的重要措施。 3年齡越小，CO_2氣腹對(duì)機(jī)體酸堿平衡的影響越大。尤其對(duì)于小年齡兒童，加強(qiáng)圍手術(shù)期監(jiān)測(cè)及麻醉管理，術(shù)后促進(jìn)CO_2充分排空，可降低CO_2導(dǎo)致的高碳酸血癥的發(fā)生率。 4腹腔鏡腎盂輸尿管成形術(shù)后留置腎造瘺體外引流對(duì)患兒機(jī)體創(chuàng)傷最小，恢復(fù)最快。 5三種引流方式均有其適應(yīng)癥，應(yīng)根據(jù)實(shí)際情況選擇最適宜的引流方式。
[Abstract]:Objective to analyze the results of blood gas analysis after laparoscopic ureteropelvic angioplasty, and to explore the factors affecting the balance of acid and base in children with CO_2 pneumoperitoneum and its preventive and therapeutic measures. To evaluate the advantages and disadvantages and indications of different drainage methods of urinary pelvis and urine after operation. Methods 1 A total of 64 children with laparoscopic ureteroplasty and 64 children with open ureteroplasty were divided into two groups: laparoscopic group and open group. 26 children with laparoscopic ureteropelvic angioplasty were treated with air replacement of residual CO_2 at the end of the operation. As a laparoscopic intervention group, all children underwent arterial blood gas analysis at 4 hours after operation. The incidence of hypercapnia was compared between the laparoscopic group and the open group, the laparoscopic group and the laparoscopic intervention group. To compare the incidence of acid-base imbalance in children of different age groups. 2 90 children with laparoscopic pyeloplasty were divided into two groups: external drainage group with nephrostomy and double J tube drainage group with long period of time. The difference of postoperative complications and success rate among the three groups was compared. Results 1the incidence of hypercapnia in the laparoscopic group was higher than that in the open group (P 0.05). There was no significant difference in the incidence of metabolic acidosis between the two groups. 2 with the increase of age, the incidence of acid-base imbalance in laparoscopy group and open group decreased gradually. The incidence of acid-base imbalance in laparoscopic group was significantly higher than that in school-age group (P 0.01). The pre-school group was higher than the school-age group (P 0.05), and the infant group was compared with the pre-school group. The incidence of acid-base imbalance in the open group was significantly higher than that in the school-age group (P0.01), and that in the pre-school group was higher than that in the school-age group (P0.05). There was no significant difference between the infant group and the pre-school group (P0.05). 3The incidence of hypercapnia in the laparoscopic intervention group was lower than that in the laparoscopic group (P 0.05), and there was no significant difference between the two groups in the incidence of metabolic acidosis. (4) the incidence of gross hematuria in the external drainage group was lower than that in the double-J tube drainage group for a long time (P 0.01). The incidence of postoperative complications in the external drainage group was lower than that in the long-term double-J tube drainage group. The incidence of urinary tract infection in the external drainage group was lower than that in the long-term double-J tube drainage group. The drainage tube was blocked in the external drainage group. The incidence of greater omentum prolapse was lower than that of the short time double J tube drainage group (P 0.05), and there was no significant difference among the three groups in the incidence of anastomotic obstruction. 5 there was no significant difference in the success rate of postoperative follow-up among the three groups (P 0.05). Conclusion 1 CO_2 pneumoperitoneum was the main cause of hypercapnia in children during laparoscopic pyeloureteroplasty, and residual CO_2 in abdominal cavity was the main cause of postoperative hypercapnia. 2 adequate replacement of intraperitoneal residual CO_2 at the end of operation is an important measure to reduce postoperative hypercapnia. 3 the older the CO-2 pneumoperitoneum, the greater the effect of pneumoperitoneum on the balance of acid and base. Especially for the young children, the perioperative monitoring and anesthesia management should be strengthened to promote the full emptying of CO_2 after operation. It can reduce the incidence of hypercapnia caused by CO_2. 4 Laparoscopic ureteropelvic angioplasty with indwelling nephrostomy external drainage was the least traumatic and the fastest recovery. 5. All the three drainage methods have their indications, and the most suitable drainage methods should be selected according to the actual situation.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R726.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 ;Changes in the level of serum liver enzymes after laparoscopic surgery[J];World Journal of Gastroenterology;2003年02期

本文編號(hào)：1465173