本文關(guān)鍵詞：等離子柱狀電極在部分無(wú)管化PCNL術(shù)中的應(yīng)用研究　出處：《蚌埠醫(yī)學(xué)院》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 經(jīng)皮腎鏡取石術(shù) 無(wú)管化 等離子止血 臨床對(duì)照試驗(yàn) 安全性和有效性

【摘要】：背景和目的經(jīng)皮腎鏡取石術(shù)是目前治療腎結(jié)石重要的手術(shù)方式之一,通過(guò)腎穿刺造瘺通道完成碎石取石操作,對(duì)患者的創(chuàng)傷較小,目前已基本取代傳統(tǒng)開(kāi)放手術(shù)。經(jīng)過(guò)40年的發(fā)展,采用無(wú)管化的處理方式,即術(shù)后不留置腎造瘺管,是經(jīng)皮腎鏡碎石術(shù)重要的發(fā)展趨勢(shì)。但術(shù)中術(shù)后的出血是影響無(wú)管化成功率的關(guān)鍵因素。對(duì)于經(jīng)皮腎穿刺通道的止血,至今沒(méi)有一種切實(shí)有效的方法。我們?cè)诳偨Y(jié)前輩們經(jīng)驗(yàn)的基礎(chǔ)上,將等離子止血技術(shù)應(yīng)用于經(jīng)皮腎穿刺通道的止血處理中,并將結(jié)果與接受傳統(tǒng)經(jīng)皮腎鏡取石術(shù)的病例進(jìn)行對(duì)比研究,以期證明等離子柱狀電極在處理經(jīng)皮腎穿刺通道出血的有效性和安全性。方法從2013年12月至2015年9月所有上尿路結(jié)石患者中,按照既定標(biāo)準(zhǔn)選取40例并隨機(jī)分為兩組,20例接受采用等離子電凝止血的無(wú)管化經(jīng)皮腎鏡取石術(shù)(無(wú)管化組),另外20例行傳統(tǒng)的經(jīng)皮腎鏡取石術(shù)(傳統(tǒng)組)。應(yīng)用統(tǒng)計(jì)學(xué)方法對(duì)兩組的手術(shù)時(shí)間、發(fā)熱情況、可視化疼痛評(píng)分、鎮(zhèn)痛藥物使用率、Hb和HCT下降程度、胃腸功能恢復(fù)時(shí)間、術(shù)后住院時(shí)間和費(fèi)用、腎周血腫和積液發(fā)生率進(jìn)行對(duì)比分析。結(jié)果所有40例患者均一期碎石成功,未出現(xiàn)周圍臟器損傷,無(wú)中轉(zhuǎn)開(kāi)放病例。無(wú)管化組和傳統(tǒng)組在手術(shù)時(shí)間、清石率,術(shù)后發(fā)熱率、術(shù)后胃腸道功能恢復(fù)時(shí)間,腎周血腫和積液發(fā)生率方面,并無(wú)統(tǒng)計(jì)學(xué)差異。而在術(shù)后Hb和HCT下降幅度、術(shù)后第一天VAS評(píng)分、鎮(zhèn)痛藥物使用率、術(shù)后住院時(shí)間和費(fèi)用方面,無(wú)管化組均低于傳統(tǒng)組,且差異具有統(tǒng)計(jì)學(xué)意義。結(jié)論應(yīng)用等離子柱狀電極對(duì)PCNL工作通道經(jīng)行止血,是一種安全有效的主動(dòng)止血方式,狹小通道中使用簡(jiǎn)便、易行,對(duì)正常組織熱損傷小,可有效減少術(shù)后出血,術(shù)后不留置腎造瘺管,與傳統(tǒng)PCNL術(shù)相比,不增加術(shù)后并發(fā)癥的同時(shí)有利于患者恢復(fù),術(shù)后疼痛明顯降低,縮短住院時(shí)間,節(jié)約住院費(fèi)用。
[Abstract]:Background and objective Percutaneous nephrolithotomy is one of the most important methods in the treatment of renal calculi. At present, the traditional open surgery has been basically replaced. After 40 years of development, the management without tube, that is, no indwelling renal fistula tube after operation. It is an important development trend of percutaneous nephrolithotripsy, but the bleeding after operation is the key factor to influence the success rate of unmanaged nephrolithotripsy. So far there is no effective method. Based on the experience of our predecessors, plasma hemostasis technology has been applied to the hemostatic treatment of percutaneous renal puncture passage. The results were compared with those of traditional percutaneous nephrolithotomy. To prove the effectiveness and safety of plasma columnar electrode in the treatment of percutaneous renal hemorrhage. Methods from December 2013 to September 2015, all patients with upper urinary calculi were treated. According to the established criteria, 40 cases were randomly divided into two groups, 20 cases received plasma electrocoagulation hemostatic percutaneous nephrolithotomy (no tube group). The other 20 patients were treated with traditional percutaneous nephrolithotomy (traditional group). The time of operation, fever, visual pain score, the usage rate of analgesic drugs and the degree of decrease of HB and HCT were measured by statistical method. The recovery time of gastrointestinal function, postoperative hospitalization time and cost, the incidence of perirenal hematoma and hydrops were compared and analyzed. Results all 40 patients were successfully treated with primary lithotripsy without peripheral organ injury. In the control group and the traditional group, the time of operation, the rate of stone removal, the rate of postoperative fever, the recovery time of postoperative gastrointestinal function, the incidence of perirenal hematoma and hydrops were analyzed. There was no significant difference between the two groups. However, the decrease of HB and HCT, the VAS score on the first day after operation, the utilization rate of analgesic drugs, the postoperative hospitalization time and the cost were lower in the unmanaged group than in the traditional group. The difference is statistically significant. Conclusion Plasma columnar electrode is a safe and effective way to stop bleeding in PCNL working channel. It is simple and easy to use in narrow channel. Heat injury to normal tissue is small, can effectively reduce postoperative bleeding, no indwelling renal fistula tube, compared with the traditional PCNL surgery, no increase in postoperative complications at the same time is conducive to recovery, postoperative pain significantly reduced. Shorten the time of hospitalization and save the cost of hospitalization.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R699.2

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