CT模擬不同體位經(jīng)皮腎鏡取石術(shù)穿刺路徑及體內(nèi)臟器變化對(duì)比研究
發(fā)布時(shí)間：2018-11-21 07:31
【摘要】：目的:通過(guò)CT影像學(xué)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(xué)依據(jù)。方法:選擇在我院準(zhǔn)備接受經(jīng)皮腎鏡治療的腎結(jié)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(shù)前以斜仰臥位、側(cè)臥位及俯臥位三種體位行CTU掃描檢查,各體位通過(guò)CT影像數(shù)據(jù)均分別測(cè)量腎臟上、中、下盞后組的三個(gè)觀察指標(biāo):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(wú)覆蓋區(qū)長(zhǎng)度比,利用配對(duì)設(shè)計(jì)的秩和檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:最短經(jīng)皮腎盞穿刺通道長(zhǎng)度:俯臥位下穿刺通道均值最短,斜仰臥次之,其中(左右兩側(cè)的上、中盞側(cè)臥位對(duì)比俯臥位,右上盞組斜仰臥位對(duì)比俯臥位)對(duì)比有統(tǒng)計(jì)學(xué)差別(P0.05),余組別對(duì)比均無(wú)統(tǒng)計(jì)學(xué)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(zhǎng),俯臥位與側(cè)臥位對(duì)比不明顯,其中(左中、右上、中盞組斜仰臥位對(duì)比俯臥位,左下、右上、中、下盞組斜仰臥位對(duì)比側(cè)臥位)具有統(tǒng)計(jì)學(xué)意義(P0.05),余組別對(duì)比均無(wú)統(tǒng)計(jì)學(xué)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(duì)比俯臥位,左中、下盞及右中、下盞組側(cè)臥位對(duì)比俯臥位)具有統(tǒng)計(jì)學(xué)意義(P0.05),余組別對(duì)比均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);腋后線切面無(wú)覆蓋區(qū)長(zhǎng)度比值:斜仰臥位比值最大,俯臥位次之,對(duì)比均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:在經(jīng)皮腎鏡手術(shù)中,采取俯臥位手術(shù),對(duì)比斜仰臥位及側(cè)臥位,其穿刺路徑更短;患者在術(shù)中采取斜仰臥其術(shù)區(qū)脂肪厚度要大于其他兩種體位;側(cè)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(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】：2017
【分類號(hào)】：R699.2
本文編號(hào)：2346319
[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(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】：2017
【分類號(hào)】：R699.2
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