【摘要】：目的:通過CT影像學檢查觀察不同體位情況下PCN穿刺路徑以及腎臟、周圍臟器和組織的變化情況,為不同體位PCNL通道建立的的安全性提供科學依據(jù)。方法:選擇在我院準備接受經(jīng)皮腎鏡治療的腎結石患者40人,根據(jù)患腎部位的左右分為A、B兩組,每組各20人,兩組病人均在術前以斜仰臥位、側臥位及俯臥位三種體位行CTU掃描檢查,各體位通過CT影像數(shù)據(jù)均分別測量腎臟上、中、下盞后組的三個觀察指標:最短經(jīng)皮腎盞穿刺距離、穿刺路徑皮下脂肪厚度、最大可穿刺范圍角度以及腎臟的腋后線切面無覆蓋區(qū)長度比,利用配對設計的秩和檢驗進行統(tǒng)計學分析。結果:最短經(jīng)皮腎盞穿刺通道長度:俯臥位下穿刺通道均值最短,斜仰臥次之,其中(左右兩側的上、中盞側臥位對比俯臥位,右上盞組斜仰臥位對比俯臥位)對比有統(tǒng)計學差別(P0.05),余組別對比均無統(tǒng)計學意義(P0.05);皮下脂肪厚度:斜仰臥位下脂肪厚度均值除左上盞組低于俯臥位外,余均在三組體位中距離最長,俯臥位與側臥位對比不明顯,其中(左中、右上、中盞組斜仰臥位對比俯臥位,左下、右上、中、下盞組斜仰臥位對比側臥位)具有統(tǒng)計學意義(P0.05),余組別對比均無統(tǒng)計學意義(P0.05);最大穿刺角度:俯臥位下腎臟中、下盞可穿刺角度最小,斜仰臥位次之,其中(左中盞、右下盞組斜仰臥位對比俯臥位,左中、下盞及右中、下盞組側臥位對比俯臥位)具有統(tǒng)計學意義(P0.05),余組別對比均無統(tǒng)計學意義(P0.05);腋后線切面無覆蓋區(qū)長度比值:斜仰臥位比值最大,俯臥位次之,對比均無統(tǒng)計學意義(P0.05)。結論:在經(jīng)皮腎鏡手術中,采取俯臥位手術,對比斜仰臥位及側臥位,其穿刺路徑更短;患者在術中采取斜仰臥其術區(qū)脂肪厚度要大于其他兩種體位;側臥位及斜仰臥位比較俯臥位可明顯增加腎臟中、下盞最大穿刺角度。
[Abstract]:Objective: to observe the changes of PCN puncture pathway, kidney, peripheral organs and tissues in different postures by CT imaging examination, so as to provide scientific basis for the safety of PCNL channels in different postures. Methods: forty patients with renal calculi who were undergoing percutaneous nephroscopy in our hospital were divided into two groups according to the left and right side of the affected kidney, 20 patients in each group. The patients in the two groups were all in oblique supine position before operation. CTU scanning was performed in the lateral position and prone position. The three indexes of renal upper, middle and lower calyceal posterior group were measured by CT image data: the shortest distance of percutaneous renal calyceal puncture, the thickness of subcutaneous fat in the puncture path. The angle of the maximum puncture range and the ratio of the length of the uncovered area on the posterior axillary section of the kidney were analyzed statistically by using the rank sum test designed by pairing design. Results: the shortest length of percutaneous renal calyceal puncture passage was the shortest in prone position, followed by oblique supine position. In the right upper calyx group, there was statistical difference between the oblique supine position and the prone position (P0.05), but there was no significant difference in the other groups (P0.05). Subcutaneous fat thickness: the mean of fat thickness in oblique supine position except left superior calyx group was lower than that in prone position, the rest was the longest in the three groups, the contrast between prone position and lateral position was not obvious, among them (left middle, right upper, right upper), In the calyceal group, there was statistical significance in the oblique supine position compared with the prone position, in the lower left, right upper, middle and lower calyx groups in the oblique supine position compared with the lateral supine position (P0.05), but there was no statistical significance in the remaining group (P0.05). Maximum puncture angle: in the prone position, the lower calyceal puncture angle was the smallest, and the oblique supine position was the second, among which (left middle calyx, right lower calyx group, oblique supine position compared with prone position, left middle, lower calyx and right middle), The lateral position of the lower calyx group compared with the prone position) had statistical significance (P0.05), while the contrast of the other groups had no statistical significance (P0.05). The ratio of the length of no covering area in the posterior axillary line section: the ratio of oblique supine position was the largest, the prone position was the second, the contrast had no statistical significance (P0.05). Conclusion: in percutaneous nephroscopic surgery, the puncture path of prone position is shorter than that of oblique supine position and lateral position, and the fat thickness of the operation area in oblique supine position is larger than that in the other two positions. The lateral position and oblique supine position significantly increased the maximum puncture angle of the lower calyx in the kidney than in the prone position.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R699.2

【參考文獻】

相關期刊論文 前7條

1 鐘轉好;李小蘭;謝海輝;朱小冬;;不同手術體位對經(jīng)皮腎鏡取石術病人的影響[J];護理研究;2013年33期

2 楊夕柏;;俯臥位、仰臥位及側臥位在經(jīng)皮腎鏡碎石取石術中的應用研究[J];中國內鏡雜志;2013年10期

3 畢革文;;斜臥位經(jīng)皮腎鏡超聲氣壓彈道碎石在治療復雜腎輸尿管上段結石的臨床應用及其對患者性功能等方面的影響研究[J];中國性科學;2012年10期

4 蘇清華;梁善玲;李健;林浩群;劉建;湛海倫;;斜臥位與側臥位超聲引導微創(chuàng)經(jīng)皮腎鏡取石術的對比研究[J];中華腔鏡泌尿外科雜志(電子版);2012年05期

5 翟超;黃海文;陳平娟;唐猛;;兩種手術體位對經(jīng)皮腎鏡氣壓彈道碎石患者的影響[J];中國醫(yī)學創(chuàng)新;2012年17期

6 李海如,宋烽,邊樹芳;使用弓形俯臥位支架的護理措施[J];中華護理雜志;2001年05期

7 黃健;許可慰;郭正輝;林天歆;謝文練;韓金利;姚友生;黃海;;斜臥位微創(chuàng)經(jīng)皮腎鏡取石術55例報告[J];中華泌尿外科雜志;2007年01期

，

本文編號：2346319