【摘要】：目的：探討術(shù)中B超在MPCNL治療鹿角形腎結(jié)石中的應(yīng)用方法及技巧,觀察其臨床效果。 方法：選擇2013年1月至2014年3月期間,在昆明醫(yī)科大學(xué)第二附屬醫(yī)院泌尿外科二病區(qū)行MPCNL治療的60例鹿角形腎結(jié)石成人患者,均采用B超引導(dǎo)穿刺建立通道和鈥激光碎石。對照組30例(34側(cè)結(jié)石)：B超引導(dǎo)穿刺建立1-2個(gè)通道取石,術(shù)中在輸尿管鏡直視下查找結(jié)石并檢查各個(gè)腎盞,至鏡下未見結(jié)石后結(jié)束手術(shù)。實(shí)驗(yàn)組30例(35側(cè)結(jié)石)：結(jié)合術(shù)前KUB、IVU和CT設(shè)計(jì)通道,先用B超引導(dǎo)建立最佳通道(能夠最大程度取石的通道)取石,術(shù)中應(yīng)用B超從腎臟各個(gè)切面掃描,引導(dǎo)腎盂內(nèi)結(jié)石清除并定位殘余結(jié)石具體位置,引導(dǎo)輸尿管鏡查找結(jié)石,對于平行盞或盞頸狹窄等無法進(jìn)入的腎盞內(nèi)結(jié)石,再利用B超定位建立通道取石,最后經(jīng)B超反復(fù)掃描各個(gè)腎盞,確認(rèn)無結(jié)石后,結(jié)束手術(shù)。將兩組一期的結(jié)石取凈率、手術(shù)時(shí)間、術(shù)中出血量、并發(fā)癥發(fā)生率、術(shù)后住院時(shí)間、手術(shù)及術(shù)后住院費(fèi)用等指標(biāo)進(jìn)行對比分析。 結(jié)果：一期手術(shù)結(jié)石取凈率：對照組22/34(64.7%),實(shí)驗(yàn)組32/35(91.4%),P0.05。手術(shù)時(shí)間：對照組102.75±24.63min,實(shí)驗(yàn)組83.43±21.06min, P0.05。術(shù)中出血.量：對照組120.13±46.32ml,實(shí)驗(yàn)組65.73±22.75ml,P0.05.術(shù)后感染：對照組8側(cè)(23.5%),實(shí)驗(yàn)組3例(8.57%),P0.05；輸血例數(shù)：對照組5側(cè)(14.7%),實(shí)驗(yàn)組無,P0.05；臟器損傷：對照組無(0%),實(shí)驗(yàn)組有一例損傷胸膜(2.86%),P0.05。術(shù)后住院時(shí)間：對照組9.5+2.75天,實(shí)驗(yàn)組5.85±1.37天,P0.05。手術(shù)及術(shù)后費(fèi)用：對照組22645.27±8101.4元,實(shí)驗(yàn)組12708.64±3437.38元,P0.05。 結(jié)論：MPCNL治療鹿角形結(jié)石中,術(shù)中系統(tǒng)化的應(yīng)用B超能夠提高一期結(jié)石取凈率,手術(shù)時(shí)間、手術(shù)并發(fā)癥、住院時(shí)間及費(fèi)用并不多于非系統(tǒng)化使用B超的對照組。
[Abstract]:Objective: to explore the application method and technique of intraoperative B-ultrasound in the treatment of staghorn kidney stones with MPCNL, and to observe its clinical effect. Methods: from January 2013 to March 2014, 60 adult patients with staghorn kidney stones were treated with MPCNL in the Department of Urology, the second affiliated Hospital of Kunming Medical University. In the control group, 30 cases (34 sides of stones) were treated with B-ultrasound guided puncture. The stones were found under the direct vision of ureter and each renal calyx was examined during the operation, and the operation was completed after no stones were found under the microscope. 30 cases (35 sides of stones) in the experimental group: combined with KUB,IVU and CT before operation, the best channel (the channel that could take the stone to the greatest extent) was established under the guidance of B-ultrasound, and the B-ultrasound was used to scan the various sections of the kidney during the operation. Guide the removal and location of residual stones in the renal pelvis, guide the ureter mirror to find the stones, for parallel calyceal or calyceal neck stenosis and other inaccessible renal calyceal stones, and then use B-ultrasound localization to establish a channel for stone extraction. Finally, each calyx was scanned repeatedly by B-ultrasound, and the operation was completed after confirming that there were no stones. The stone removal rate, operation time, intraoperative bleeding volume, incidence of complications, postoperative hospitalization time, operation and postoperative hospitalization expenses were compared and analyzed between the two groups. Results: the stone removal rate of the first stage operation was 22 鈮，

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