本文關(guān)鍵詞： 腎盂內(nèi)壓 梗阻性結(jié)石 微創(chuàng) 鈥激光 經(jīng)皮腎鏡　出處：《南昌大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過測量微創(chuàng)經(jīng)皮腎鏡鈥激光碎石術(shù)治療梗阻性結(jié)石術(shù)中分別使用18Fr及20Fr peel-away鞘在三種體位下腎盂內(nèi)壓的變化，對(duì)腎盂內(nèi)壓進(jìn)行比較分析。了解微創(chuàng)經(jīng)皮腎鏡鈥激光碎石術(shù)治療梗阻性結(jié)石術(shù)中腎盂內(nèi)壓的安全性,并比較使用不同體位及不同鞘時(shí)腎盂內(nèi)壓的大小，同時(shí)比較在不同體位下患者的手術(shù)耐受性。 方法：選擇腎盂或輸尿管出口有梗阻的結(jié)石患者（輸尿管上段結(jié)石、腎盂結(jié)石、多發(fā)性腎結(jié)石及鑄型腎結(jié)石），在MPCNL術(shù)中隨機(jī)使用18Fr或20Frpeel-away鞘并隨機(jī)采用俯臥位、斜俯臥位及側(cè)臥位對(duì)其進(jìn)行分組，利用壓力傳感器在術(shù)中測量腎盂內(nèi)壓，并利用心電監(jiān)護(hù)儀及計(jì)算機(jī)對(duì)數(shù)據(jù)進(jìn)行記錄。 結(jié)果： （1）MPCNL治療梗阻性結(jié)石術(shù)中采用18Fr鞘在俯臥位、斜俯臥位及側(cè)臥位下測量各組術(shù)中腎盂內(nèi)壓平均值分別為27.53±3.58cmH2O、26.51±3.26cmH2O及21.65±2.97cmH2O。各組術(shù)中平均腎盂內(nèi)壓均低于一般所認(rèn)為的引起腎實(shí)質(zhì)返流極限(40cmH2O)。腎盂內(nèi)壓在俯臥位組最高，而在側(cè)臥位組時(shí)最低：俯臥位組與斜俯臥位組之間無統(tǒng)計(jì)學(xué)差異(P=0.236)，但都顯著高于側(cè)臥位組(P=0.000，0.001)，具有統(tǒng)計(jì)學(xué)意義。 （2）MPCNL治療梗阻性結(jié)石術(shù)中采用20Fr鞘在俯臥位、斜俯臥位及側(cè)臥位下測量各組術(shù)中腎盂內(nèi)壓平均值分別為26.60±3.51cmH2O、25.27±3.25cmH2O及20.99±2.73cmH2O。各組術(shù)中平均腎盂內(nèi)壓均低于一般所認(rèn)為的引起腎實(shí)質(zhì)返流極限(40cmH2O)。腎盂內(nèi)壓在俯臥位組與斜俯臥位組之間無統(tǒng)計(jì)學(xué)差異(P=0.217)，但都顯著高于側(cè)臥位組(P=0.01，，0.04)，側(cè)臥位組與俯臥位組及斜俯臥位組之間有統(tǒng)計(jì)學(xué)意義。 （3）MPCNL術(shù)中分別采用俯臥位、斜俯臥位及側(cè)臥位時(shí)，18Fr與20Fr鞘術(shù)中平均腎盂內(nèi)壓均無統(tǒng)計(jì)學(xué)意義（P=0.275，P=0.177，P=0.236）。 （4）MPCNL術(shù)中采用俯臥位、斜俯臥位及側(cè)臥位時(shí)，術(shù)中患者出現(xiàn)呼吸或心前區(qū)不適的手術(shù)例數(shù)分別為7、1、0。斜俯臥位與俯臥位相比有統(tǒng)計(jì)學(xué)意義（0.02＜P＜0.05），側(cè)臥位與俯臥位相比具有顯著的統(tǒng)計(jì)學(xué)意義（0.005＜P＜0.01），斜俯臥位與側(cè)臥位相比無統(tǒng)計(jì)學(xué)意義（0.2＜P＜0.4）。 結(jié)論： （1）在微創(chuàng)經(jīng)皮腎鏡鈥激光碎石術(shù)治療梗阻性結(jié)石術(shù)中，采用側(cè)臥位可明顯降低術(shù)中腎盂內(nèi)壓。 （2）微創(chuàng)經(jīng)皮腎鏡鈥激光碎石術(shù)治療梗阻性結(jié)石時(shí)，采用俯臥位、斜俯臥位及側(cè)臥位時(shí)腎盂內(nèi)壓均低于引起灌注液反流的壓力極限值（40cmH2O）。 （3）微創(chuàng)經(jīng)皮腎鏡鈥激光碎石術(shù)術(shù)中采用斜俯臥位及側(cè)臥位可改善患者手術(shù)耐受性。
[Abstract]:Objective: to measure the changes of intrapelvic pressure in patients with obstructive calculi treated by minimally invasive percutaneous nephrolithotripsy with holmium: YAG laser lithotripsy with 18Fr and 20Fr peel-away sheath in three different positions, respectively. To study the safety of minimally invasive percutaneous nephrolithotripsy in the treatment of obstructive calculi, and to compare the size of intrapyelic pressure in different positions and different sheaths, and to compare the safety of intrapyelic pressure in the treatment of obstructive calculi with holmium laser lithotripsy with minimally invasive percutaneous nephrolithotripsy. At the same time, the operating tolerance of patients in different positions was compared. Methods: patients with renal pelvis or ureteral outlet obstruction (upper ureteral calculi, renal pelvis stones, multiple renal calculi and cast renal calculi) were randomly treated with 18Fr or 20Frpeel-away sheath and prone position during MPCNL. They were divided into oblique prone position and lateral position. The pressure sensor was used to measure intrapelvic pressure during operation and ECG monitor and computer were used to record the data. Results:. MPCNL was used to treat obstructive calculi in prone position with 18Fr sheath. The mean intrapelvic pressure was 27.53 鹵3.58 cmH2O 26.51 鹵3.26 cmH2O and 21.65 鹵2.97 cmH2O in oblique prone position and lateral position respectively. The intrapelvic pressure in each group was lower than 40 cm H _ 2O, which caused the limit of renal parenchymal reflux. The intrapelvic pressure was the highest in the prone position group. But in the lateral position group, there was no statistical difference between the prone position group and the oblique prone position group, but they were significantly higher than that in the lateral position group. MPCNL was used to treat obstructive calculi with 20Fr sheath in prone position. The mean intrapelvic pressure in each group was 26.60 鹵3.51 cmH2O 25.27 鹵3.25 cmH2O and 20.99 鹵2.73 cmH2O respectively. The intraoperative mean intrapelvic pressure in each group was lower than the 40 cm H _ 2O limit for renal parenchymal reflux. The intrapelvic pressure in prone position group and oblique prone position group was lower than that in each group. There was no statistical difference between the two groups (P < 0. 217), but they were significantly higher than those in the lateral position group (P < 0. 01). There was statistical significance between the lateral position group, the prone position group and the oblique prone position group. There was no significant difference in the mean intrapelvic pressure between 18Fr and 20Fr during MPCNL, oblique prone position and lateral position. In MPCNL, prone position, oblique prone position and lateral position were used. There were 0. 02 < 0. 02 < P < 0. 05 in oblique prone position and 0. 02 < P < 0. 05 in prone position, 0. 005 < P < 0. 01 in lateral position and 0. 005 < P < 0. 01 in prone position, and 0. 2 < P < 0. 40 in oblique prone position. Conclusion:. During minimally invasive percutaneous nephrolithotripsy with holmium: YAG laser lithotripsy, lateral recumbent position can significantly reduce intrapelvic pressure. (2) during minimally invasive percutaneous nephrolithotripsy with holmium: YAG laser lithotripsy, the pressure of renal pelvis in prone position, oblique prone position and lateral position was lower than the pressure limit of 40 cm H 2O. Minimally invasive percutaneous nephrolithotripsy with holmium: YAG laser lithotripsy in oblique prone position and lateral position can improve the patient's tolerance.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699.2

【引證文獻(xiàn)】

相關(guān)期刊論文 前2條

1 龔墅;羅晉揚(yáng);賴小斌;;截石位聯(lián)合斜仰臥位在微創(chuàng)經(jīng)皮腎碎石取石術(shù)中的應(yīng)用效果[J];中國醫(yī)學(xué)工程;2017年08期

2 鄭卓敏;莊澤平;李冕華;黃蕓珊;陳燕東;;不同手術(shù)體位在老年肥胖患者經(jīng)皮腎鏡取石術(shù)中的應(yīng)用效果觀察[J];中國醫(yī)藥科學(xué);2016年09期

本文編號(hào)：1514938