發(fā)布時(shí)間：2018-04-21 08:45

  本文選題：經(jīng)皮腎鏡取石術(shù) + 復(fù)雜性腎結(jié)石��； 參考：《瀘州醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：通過對(duì)比不同通道選擇情況下行經(jīng)皮腎鏡取石術(shù)(Percutaneousnephrolithotomy, PCNL)治療復(fù)雜性腎結(jié)石的安全性及治療效果，為復(fù)雜性腎結(jié)石治療方案的選擇提供理論依據(jù)。方法：自2011年7月開始，將瀘州醫(yī)學(xué)院附屬宜賓市第一人民醫(yī)院泌尿外科收治的腎結(jié)石患者按設(shè)計(jì)的入選標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)進(jìn)行篩查并簽署知情同意書，對(duì)獲得的病例按入選時(shí)間的先后順序編號(hào)，按編號(hào)依次歸入標(biāo)準(zhǔn)通道組、微通道組、雙微通道組。所有患者均行經(jīng)皮腎鏡取石術(shù)，實(shí)驗(yàn)進(jìn)行至2012年7月，共獲得病例126例，每組病例數(shù)為42例。其中標(biāo)準(zhǔn)通道組患者年齡(47.9±12.6)歲；微通道組年齡(50.3±13.6)歲；雙微通道組年齡(48.2±14.4)歲。標(biāo)準(zhǔn)通道組結(jié)石大小(4.16±1.18)cm；微通道組結(jié)石大小(4.45±1.26)cm；雙微通道組結(jié)石大小(4.29±1.26)cm。所有患者均在彩超引導(dǎo)下進(jìn)行PCNL，將三組患者的手術(shù)時(shí)間、結(jié)石清除率、術(shù)后住院時(shí)間進(jìn)行對(duì)比，，比較各組治療效果的差異；將三組患者術(shù)中及術(shù)后并發(fā)癥發(fā)生率、出血量進(jìn)行對(duì)比，比較各組安全性的差異。結(jié)果：126例患者均順利完成手術(shù)，并發(fā)癥發(fā)生率分別是標(biāo)準(zhǔn)通道組14.29%、微通道組9.52%、雙微通道組9.52%。微通道組與雙微通道組并發(fā)癥率相同，將這兩組與標(biāo)準(zhǔn)通道組比較，經(jīng)過2檢驗(yàn)（2=0.454，P=0.736），差異無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后結(jié)石清除率：標(biāo)準(zhǔn)通道組69.05%，微通道組66.67%，雙微通道組88.10%。標(biāo)準(zhǔn)通道組與微通道組間結(jié)石清除率比較，經(jīng)χ2檢驗(yàn)（χ2=0.055，P=0.815）,差異無統(tǒng)計(jì)學(xué)意義(P0.05)；標(biāo)準(zhǔn)通道組與雙微通道組間結(jié)石清除率比較，經(jīng)χ2檢驗(yàn)（χ2=4.525，P=0.033）,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；微通道組與雙微通道組間結(jié)石清除率比較，經(jīng)χ2檢驗(yàn)（χ2=5.509，P=0.019）,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)于結(jié)石長(zhǎng)徑大于等于5cm的病例，標(biāo)準(zhǔn)通道組結(jié)石清除率為33.33%，微通道組結(jié)石清除率為30.77%，雙微通道組結(jié)石清除率為75%，標(biāo)準(zhǔn)通道組與微通道組間結(jié)石清除率比較，經(jīng)χ2檢驗(yàn)（χ2=0.012，P=0.851）,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。標(biāo)準(zhǔn)通道組與雙微通道組間結(jié)石清除率比較，經(jīng)χ2檢驗(yàn)（χ2=5.239，P=0.022）,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。微準(zhǔn)通道組與雙微通道組間結(jié)石清除率比較，經(jīng)χ2檢驗(yàn)（χ2=3.576，P=0.027）,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。手術(shù)時(shí)間比較：標(biāo)準(zhǔn)通道組(67.98±27.61)分鐘；微通道組(69.76±24.79)分鐘；雙微通道組(61.79±21.21)分鐘。三組患者手術(shù)時(shí)間兩兩配對(duì)經(jīng)t檢驗(yàn)，差別均無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)中出血量比較：標(biāo)準(zhǔn)通道組(70.71±40.18)ml；微通道組(78.71±36.51)ml；雙微通道組(79.69±40.84)ml。三組患者術(shù)中出血量?jī)蓛膳鋵?duì)經(jīng)t檢驗(yàn)，差別均無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后住院時(shí)間:標(biāo)準(zhǔn)通道組(8.45±2.66)天；微通道組(8.33±3.06)天；雙微通道組(8.00±1.93)天，三組患者術(shù)中術(shù)后住院時(shí)間兩兩配對(duì)經(jīng)t檢驗(yàn)，差別均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：標(biāo)準(zhǔn)通道、微通道、雙微通道PCNL治療復(fù)雜性腎結(jié)石在手術(shù)時(shí)間、術(shù)中出血量、并發(fā)癥率及術(shù)后住院時(shí)間這幾項(xiàng)指標(biāo)中無明顯差別。一期單通道PCNL治療復(fù)雜性腎鑄型結(jié)石術(shù)后殘石率較雙微通道高，往往需要二期手術(shù)。雙微通道治療復(fù)雜性腎結(jié)石能明顯提高結(jié)石清除率，出血量及術(shù)后并發(fā)癥并沒有增加，可作為復(fù)雜性結(jié)石、特別是結(jié)石長(zhǎng)徑大于等于5cm的全鑄型結(jié)石的首選治療方式。
[Abstract]:Objective : To study the safety and therapeutic effects of percutaneous nephrolithotripsy ( PCNL ) in the treatment of complicated renal calculus by contrast of different channel selection . Methods : From July 2011 , the patients with renal calculus treated by urological surgery in the First People ' s Hospital of the City of Luzhou Medical College were screened and signed the informed consent form . All patients were enrolled in the standard channel group , the micro - channel group and the double - micro - channel group according to the selection criteria and exclusion criteria .
Age of micro channel group ( 50.3 鹵 13.6 ) years ;
The age ( 48.2 鹵 14.4 ) years in the dual microchannel group . The size of the standard channel group was ( 4.16 鹵 1.18 ) cm .
Microchannel group stone size ( 4.45 鹵 1.26 ) cm ;
The size of the stones ( 4.29 鹵 1.26 ) cm in the double micro - channel group was 4.29 鹵 1.26 cm . All patients were treated with PCNL under the guidance of color Doppler ultrasound . The operative time , stone clearance rate and hospitalization time of the three groups were compared , and the difference of treatment effect was compared .
Results : The incidence of postoperative complications was 14.29 % in the standard channel group , 9.52 % in the micro - channel group and 9.52 % in the double - micro - channel group . The rate of postoperative stone clearance was 69.05 % in the standard channel group , 66.67 % in the micro - channel group and 88.10 % in the double - micro - channel group .
The rate of stone clearance between the standard channel group and the double micro - channel group was significantly higher than that of the double micro - channel group ( 蠂2 = 4.525 , P = 0.033 ) , and the difference was statistically significant ( P0.05 ) .
The rate of stone clearance in the standard channel group was 33.33 % , the rate of stone clearance in the micro - channel group was 33.33 % , the stone clearance rate in the micro - channel group was 33.33 % , the stone clearance rate in the micro - channel group was 30.77 % , the rate of stone clearance between the standard channel group and the micro - channel group was 75 % , the difference was significant ( P0.05 ) .
Microchannel group ( 69.76 鹵 24.79 ) minutes ;
There was no significant difference in the operative time between the two groups ( 61.79 鹵 21.21 ) minutes . There was no statistical difference between the two groups ( P0.05 ) .
Microchannel group ( 78.71 鹵 36.51 ) ml ;
There was no significant difference between the two groups ( 79.69 鹵 40.84 ) ml in the two groups ( 79.69 鹵 40.84 ) ml . There was no significant difference between the two groups ( P0.05 ) .
Microchannel group ( 8.33 鹵 3.06 ) days ;
Conclusion : The standard channel , micro - channel and double micro - channel PCNL have no significant difference in the operative time , the bleeding volume , the complication rate and the time of hospitalization . Conclusion : The single - channel PCNL in the treatment of complicated renal calculi has a higher residual stone rate than the double micro - channel .

【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 劉永達(dá);袁堅(jiān);李遜;賴清;羅金泰;劉冠;伍筱梅;;微創(chuàng)經(jīng)皮腎鏡取石術(shù)并發(fā)嚴(yán)重出血的處理[J];中國(guó)醫(yī)師雜志;2006年04期

本文編號(hào)：1781715