【摘要】：目的：探討CT引導(dǎo)經(jīng)皮腎穿刺造瘺聯(lián)合二期經(jīng)皮腎鏡治療感染性鹿角形腎結(jié)石的有效性及安全性。 方法：回顧性分析邵逸夫醫(yī)院在2011年1月至2013年12月期間收治的30例感染性鹿角形腎結(jié)石患者。所有患者均行B超、KUB、CT、尿常規(guī)及中段尿培養(yǎng)及術(shù)后結(jié)石成分分析等明確診斷為感染性鹿角形腎結(jié)石。其中12例行CT引導(dǎo)經(jīng)皮腎穿刺造瘺聯(lián)合二期經(jīng)皮腎鏡治療(CT組),18例行術(shù)中B超引導(dǎo)經(jīng)皮腎穿刺一期經(jīng)皮腎鏡治療(B超組)。比較兩組病人在手術(shù)時(shí)間、術(shù)中出血量、總住院費(fèi)用、術(shù)后住院時(shí)間、結(jié)石清除率及術(shù)后并發(fā)癥等情況上的差異。 結(jié)果：兩組患者在性別、腎積水情況、結(jié)石最長(zhǎng)徑、S.T.O.N.E. Nephrolithometry評(píng)分等比較無顯著性差異(P0.05),年齡上存在顯著性差異(P0.05),CT組平均年齡(61.2±11.7)歲,B超組平均年齡(52.0±11.8)歲。CT組和B超組手術(shù)時(shí)間分別為(118±15.7)min和(151.9±35.3)mmin,術(shù)中出血量分別為(37.1±17.9)ml和(68.9±43.3)ml,總住院費(fèi)用分別為(31.4±3.8)千元和(28.3±3.6)千元,術(shù)后住院時(shí)間分別為(4.5±1.2)天和(5.6±1.2)天,一次清石率分別為91.7%(11/12)和83.3%(15/18),術(shù)后并發(fā)癥分別為16.7%(2/12)和33.3%(6/18),均存在統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論：相比B超引導(dǎo)經(jīng)皮腎穿刺一期經(jīng)皮腎鏡碎石術(shù),CT引導(dǎo)經(jīng)皮腎穿刺造瘺二期經(jīng)皮腎鏡碎石術(shù)具有手術(shù)時(shí)間短,術(shù)中出血少、術(shù)后恢復(fù)快、并發(fā)癥少、結(jié)石一次清除率高等優(yōu)點(diǎn),但是總住院費(fèi)用較B超引導(dǎo)經(jīng)皮腎穿刺一期經(jīng)皮腎鏡碎石術(shù)高。
[Abstract]:Objective: to evaluate the efficacy and safety of CT guided percutaneous nephrostomy combined with two stage percutaneous nephroscopy in the treatment of infectious staghorn nephrolithiasis. Methods: thirty patients with infectious staghorn renal calculi from January 2011 to December 2013 in Shaw Hospital were retrospectively analyzed. All patients were diagnosed as infective staghorn nephrolithiasis by B ultrasound, KUB,CT, urine routine, middle urine culture and postoperative stone composition analysis. Twelve cases were treated with CT guided percutaneous nephrostomy combined with second stage percutaneous nephroscopy (CT group), and 18 cases were treated by B-ultrasound guided percutaneous nephrolithotomy (B-ultrasound group). The differences of operation time, intraoperative bleeding volume, total hospitalization cost, postoperative hospitalization time, stone clearance rate and postoperative complications were compared between the two groups. Results: there was no significant difference in sex, hydronephrosis, the longest diameter of stone, S.T.O.N.E. Nephrolithometry score between the two groups (P0.05), but there was significant difference in age (P0.05). The mean age of CT group was (61.2 鹵11.7) years, and that of B-ultrasound group was (52.0 鹵11.8) years. The operative time of CT group and B-ultrasound group were (118 鹵15.7) min and (151.9 鹵35.3) mmin, respectively. The total hospitalization expenses of (37.1 鹵17.9) ml and (68.9 鹵43.3) ml, were (31.4 鹵3.8) thousand yuan and (28.3 鹵3.6) thousand yuan, respectively. The duration of hospitalization was (4.5 鹵1.2) days and (5.6 鹵1.2) days, respectively. The stone removal rates were 91.7% (11 / 12) and 83.3% (15 / 18), respectively. Postoperative complications were 16. 7% (2 / 12) and 33. 3% (6 / 18), respectively, which were statistically significant (P0.05). Conclusion: compared with B-ultrasound guided percutaneous nephrolithotripsy, CT guided percutaneous nephrolithotripsy has shorter operation time, less intraoperative bleeding, faster recovery and fewer complications. The cost of total hospitalization was higher than that of percutaneous nephrolithotripsy guided by B-ultrasound in one stage percutaneous nephrolithotripsy.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699

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