本文選題：PCNL + 超聲��； 參考：《廣西醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的：評(píng)價(jià)配備專(zhuān)業(yè)凸陣穿刺探頭的B超引導(dǎo)經(jīng)皮腎穿刺建立工作通道在PCNL手術(shù)中的臨床價(jià)值。方法：選取2014年1月至2015年1月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院泌尿外科行PCNL手術(shù)(采用專(zhuān)業(yè)凸陣穿刺B超探頭引導(dǎo)建立工作通道)的病例177例,其中男112例,女65例,年齡15-71歲,平均44±14.21歲。統(tǒng)計(jì)每例患者手術(shù)通道建立時(shí)間、腎盞入路、手術(shù)時(shí)間、術(shù)中出血量、并發(fā)癥、結(jié)石清除率、術(shù)后住院時(shí)間,作為實(shí)驗(yàn)組。另外,收集2010年1月至2012年1月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院泌尿外科行PCNL手術(shù)(采用普通B超探頭或X線(xiàn)引導(dǎo)建立工作通道)的病例152例作為對(duì)照組進(jìn)行比較分析。其中男95例,女57例,年齡13-78歲,平均46±12.77歲。結(jié)果：所用患者均完成通道建立及PCNL過(guò)程。實(shí)驗(yàn)組腎通道建立時(shí)間10.36±2.54min,上盞穿刺84例(47.5%),中盞穿刺72例(40.7%),下盞穿刺21例(11.9%),雙通道7例(3.9%),三通道4例(2.6%)。手術(shù)時(shí)間41-177分鐘,平均70.61±20.23分鐘,術(shù)中失血5-200ml,平均41.76±31.97ml,術(shù)后平均住院5.75±2.09天。清石率88.14%(156/177),其中2例患者出現(xiàn)氣胸,給予對(duì)癥治療后好轉(zhuǎn),無(wú)需胸腔閉式引流,6例患者術(shù)后感染發(fā)熱；術(shù)后出血8例,其中7例保守治療好轉(zhuǎn),1例行動(dòng)脈栓塞治療好轉(zhuǎn)。因術(shù)中大出血轉(zhuǎn)開(kāi)放手術(shù)病例1例。對(duì)照組腎通道建立時(shí)間15.08±3.18min,上盞穿刺55例(36.2%),中盞穿刺73例(48.0%),下盞穿刺24例(15.8%),雙通道9例(5.9%),三個(gè)通道4例(2.6%)。手術(shù)時(shí)間45-120分鐘,平均81.13±19.71分鐘,術(shù)中失血5～200ml,平均67.76±39.66ml,術(shù)后平均住院6.19±2.46天。清石率80.26%(122/152),其中1例患者出現(xiàn)氣胸,給予對(duì)癥治療后好轉(zhuǎn),無(wú)需胸腔閉式引流,1例患者術(shù)中輸尿管連接部粘膜撕裂,保守治療好轉(zhuǎn)。6例患者術(shù)后感染發(fā)熱；術(shù)后出血8例,保守治療好轉(zhuǎn)。無(wú)術(shù)中出血轉(zhuǎn)開(kāi)放手術(shù)病例。經(jīng)統(tǒng)計(jì)學(xué)分析,結(jié)果顯示兩組患者在手術(shù)通道建立時(shí)間、腎盞入路、手術(shù)時(shí)間、結(jié)石清除率、術(shù)后住院時(shí)間上有顯著性差異(P0.05),而并發(fā)癥的發(fā)生率無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論：配備專(zhuān)業(yè)凸陣穿刺探頭的B超能夠安全、有效地引導(dǎo)經(jīng)皮腎穿刺,建立工作通道,在PCNL治療中有很好的臨床應(yīng)用價(jià)值。
[Abstract]:Objective: to evaluate the clinical value of B-ultrasound guided percutaneous renal puncture in PCNL operation.Methods: from January 2014 to January 2015, 177 patients (112 males and 65 females) underwent PCNL operation in Urology Department, the first affiliated Hospital of Guangxi Medical University.The average age was 44 鹵14.21 years old.The time of establishing operation passage, the time of operation, the amount of intraoperative bleeding, the complications, the rate of stone clearance, the time of hospitalization after operation were counted as the experimental group.In addition, from January 2010 to January 2012, 152 patients who underwent PCNL operation in the Urology Department of the first affiliated Hospital of Guangxi Medical University (using common B-ultrasound probe or X-ray guidance to establish the working channel) were compared and analyzed as the control group.There were 95 males and 57 females, aged 13 to 78 years, with an average age of 46 鹵12.77 years.Results: all the patients completed the process of channel establishment and PCNL.In the experimental group, the time of establishing renal passage was 10.36 鹵2.54 min, the upper calyceal puncture was 47.5 minutes, the middle calyceal puncture was 40.7m, the inferior calyceal puncture was 11.9T, the double channel was 3.9T, and the three-channel was 2.6C.The operative time was 41-177 minutes (mean 70.61 鹵20.23 minutes), the blood loss during operation was 5-200 ml (mean 41.76 鹵31.97 ml), and the average hospital stay was 5.75 鹵2.09 days.The rate of clearing stone was 88.14% of 156 / 177, of which 2 cases had pneumothorax, 6 cases had fever and infection without chest closed drainage, and 8 cases had postoperative hemorrhage, among which 7 cases were improved by conservative treatment and 1 case by arterial embolization.One case was converted to open operation due to massive intraoperative hemorrhage.In the control group, the time of establishing renal passage was 15.08 鹵3.18 min, that of upper calyceal puncture was 36.2 minutes, that of middle calyceal puncture was 48.0, that of lower calyceal puncture was 15.8, that of double channel was 5.9 and that of three channels was 2.6.The operative time was 45-120 minutes (mean 81.13 鹵19.71 minutes), and the blood loss during operation was 57.76 鹵39.66 ml, and the average hospital stay was 6.19 鹵2.46 days.The stone clearance rate was 80.26 / 122 / 152, in which one patient developed pneumothorax, improved after symptomatic treatment, 1 patient did not need closed thoracic drainage, 1 patient underwent intraoperative ureteral junction mucosal tear, 6 patients received conservative treatment, 6 patients became infected and febrile after operation, 8 patients suffered from postoperative haemorrhage.Conservative treatment improved.No intraoperative bleeding was converted to open operation.The results of statistical analysis showed that there were significant differences between the two groups in the time of establishing operation channel, renal calyceal approach, operation time, stone clearance rate and postoperative hospitalization time (P 0.05), but the incidence of complications was not statistically significant.Conclusion: B-ultrasound equipped with professional convex array puncture probe can guide percutaneous renal puncture effectively and establish working channel. It has good clinical application value in the treatment of PCNL.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R699

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 汪瑞民,王丙良,龍敦超;B超導(dǎo)向穿刺診斷不典型肝占位的應(yīng)用分析[J];中國(guó)醫(yī)學(xué)影像技術(shù);1991年03期

2 潘富林;齊繼連;何成文;陳薇薇;邵雷;李萍華;陳鏗;;非穿刺探頭超聲導(dǎo)向經(jīng)皮腎穿刺活檢術(shù)的改良應(yīng)用[J];中國(guó)當(dāng)代醫(yī)藥;2013年03期

3 翟慎林,鄭云江;非穿刺探頭超聲引導(dǎo)經(jīng)皮肝膽道置管引流的臨床應(yīng)用研究[J];實(shí)用放射學(xué)雜志;1999年04期

4 吳全理;李齊廣;劉仁濱;黃少偉;吳志亮;馮秀昌;梁昭美;;B超引導(dǎo)下穿刺在肝膽外科的應(yīng)用[J];廣西醫(yī)學(xué);1989年02期

5 熊仕友;自制B超穿刺儀[J];中國(guó)醫(yī)學(xué)影像技術(shù);1989年04期

6 董寶瑋;超聲引導(dǎo)細(xì)針穿刺活檢在臨床的應(yīng)用[J];實(shí)用外科雜志;1992年05期

7 劉浩;;專(zhuān)用穿刺探頭導(dǎo)向下介入治療腎囊腫30例效果分析[J];咸寧學(xué)院學(xué)報(bào)(醫(yī)學(xué)版);2012年04期

8 譚華;張浩;冉玉力;張勇;夏明銀;李錦;;便攜式B超引導(dǎo)和彩超穿刺探頭引導(dǎo)下腎活檢的應(yīng)用對(duì)比[J];中國(guó)實(shí)用醫(yī)藥;2013年10期

9 章峰;項(xiàng)阿夫;趙宗民;牛曉楓;;經(jīng)皮穿刺置管引流治療腹腔膿腫[J];臨床醫(yī)學(xué);1985年05期

10 李燕燕;;B超導(dǎo)向穿刺抽吸活檢在腹部腫瘤中的應(yīng)用[J];中國(guó)腫瘤臨床;1988年05期

相關(guān)會(huì)議論文 前2條

1 魯成發(fā);;超聲導(dǎo)向腎活檢—普通探頭與穿刺探頭穿刺效果的比較[A];中華醫(yī)學(xué)會(huì)超聲醫(yī)學(xué)新進(jìn)展學(xué)術(shù)會(huì)議論文匯編[C];2004年

2 陳磊;陳嶸;陳忠;胡兵;;超聲引導(dǎo)下腎鏡碎石術(shù)不同穿刺引導(dǎo)方法及徑路優(yōu)劣的初步探討[A];中國(guó)超聲醫(yī)學(xué)工程學(xué)會(huì)第九屆全國(guó)腹部超聲醫(yī)學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2012年

相關(guān)碩士學(xué)位論文 前1條

1 梁正方;配備專(zhuān)業(yè)凸陣穿刺探頭的超聲引導(dǎo)經(jīng)皮腎穿刺建立工作通道在PCNL手術(shù)中的臨床應(yīng)用研究[D];廣西醫(yī)科大學(xué);2016年

，

本文編號(hào)：1772813