本文選題：經(jīng)皮腎鏡取石術(shù) + CT尿路成像��； 參考：《昆明醫(yī)科大學(xué)》2013年碩士論文

【摘要】：[目的]：探討CT尿路成像在指導(dǎo)準(zhǔn)確定位PCNL目標(biāo)腎盞的應(yīng)用價(jià)值,并得應(yīng)用于術(shù)中對(duì)PCNL在處理腎結(jié)石的臨床價(jià)值。 [方法]：在2011年7月—2013年3月期間,選擇在昆明醫(yī)科大學(xué)第二附屬醫(yī)院微創(chuàng)泌尿外科確診為腎結(jié)石并需行PCNL治療的150例患者,其中男性121例,女性29例。年齡最大的為71歲,最小的為21歲。全部患者均經(jīng)影像學(xué)依據(jù)診斷為腎結(jié)石,同時(shí)滿足納入和排除的標(biāo)準(zhǔn)。然后隨機(jī)分成CT尿路成像組75例與不行CT尿路成像組的75例。全部患者均在常規(guī)全麻下行PCNL治療。研究組根據(jù)CTU影響學(xué)資料定位的腎盞穿刺目標(biāo)腎盞。記錄兩組患者術(shù)前的一般資料,包括年齡、體重、身高、復(fù)雜性腎結(jié)石、結(jié)石大小和病程時(shí)間等情況。獲取研究組和對(duì)照組每一名患者的手術(shù)時(shí)間、術(shù)后一期結(jié)石清除率即無石率、術(shù)后住院天數(shù)和出血輸血情況。將所得數(shù)據(jù)指標(biāo)進(jìn)行統(tǒng)計(jì)學(xué)分析處理。 [結(jié)果]：統(tǒng)計(jì)學(xué)分析表明：研究組和對(duì)照組患者術(shù)前的結(jié)石大小、病程時(shí)間、患者年齡、BMI指數(shù)和功能性獨(dú)腎患者數(shù)均無統(tǒng)計(jì)學(xué)差異。149患者的手術(shù)均順利完成,對(duì)照組有1例患者術(shù)中穿刺擴(kuò)張后出血較多,留置腎造瘺管壓迫止血好轉(zhuǎn)后改二期手術(shù)。術(shù)后均無出現(xiàn)丟腎或患者死亡的情況。研究組與對(duì)照組在接受PCNL治療腎結(jié)石的無石率分別為：64/75(83.5%)和54/75(72%)；其中復(fù)雜性腎結(jié)石患者達(dá)到無石率人數(shù)為：20(68.96%)和11(45.83%)；術(shù)后輸血人數(shù)為0人和4人；術(shù)后血紅蛋白下降較術(shù)前大于30%的人數(shù)為2人和9人；手術(shù)時(shí)間分別為：83.08±28.04min和92.94±28.50min,以上數(shù)據(jù)統(tǒng)計(jì)學(xué)分析顯示有統(tǒng)計(jì)學(xué)差異(P0.05)。研究組和對(duì)照術(shù)后平均住院天數(shù)為6.64±2.66和7.00±2.73：術(shù)中嚴(yán)重出血的人數(shù)為0人和1人；術(shù)后持續(xù)超過24h腎瘺管引流液較紅或嚴(yán)重血尿人數(shù)分別為3人和9人,均無統(tǒng)計(jì)學(xué)意義(P0.05)。 [結(jié)論]：CT尿路成像可清晰的了解腎盂腎盞和結(jié)石的解剖形態(tài)及其二者之間的關(guān)系,對(duì)擬行PCNL治療的腎結(jié)石患者,可以達(dá)到準(zhǔn)確的定位最佳的目標(biāo)腎盞,對(duì)術(shù)中在C臂X線監(jiān)視下,對(duì)穿刺和建立通道有指導(dǎo)意義。CT尿路成像通過指導(dǎo)選擇最佳目標(biāo)腎盞,并對(duì)穿刺目標(biāo)腎盞和建立通道有指導(dǎo)意義,從而可以提高結(jié)石清除率、減少術(shù)后輸血率和減少手術(shù)時(shí)間,減少術(shù)后出血相關(guān)并發(fā)癥,提高PCNL治療腎結(jié)石的療效,值得在臨床上推廣應(yīng)用。
[Abstract]:[Objective] to explore the application value of CT urogram in guiding accurate location of PCNL target calyx, and to be applied to the clinical value of PCNL in the treatment of renal calculi.
[method]: from July 2011 to March 2013, 150 patients with renal calculi and PCNL treatment were selected at the Second Affiliated Hospital of the Second Affiliated Hospital of Kunming Medical University, including 121 males and 29 females. The oldest was 71 years old and the smallest was 21 years old. All patients were diagnosed as kidney stones by imaging basis, and satisfied at the same time. The criteria for inclusion and exclusion were randomly divided into 75 patients in the CT urological group and 75 in the non CT urological group. All the patients were treated with PCNL under general anesthesia. The study group was based on the target renal calycalycacal calyx based on the CTU data. The general data of two groups of patients were recorded, including age, weight, height, and complex renal calculi. The operation time of each patient in the study group and the control group was obtained, the stone clearance rate was no stone rate, the number of days after the operation and the condition of blood transfusion after the operation. The data were analyzed statistically.
[results]: statistical analysis showed that the size, course time, age of the patients, BMI index and the number of functional independent kidney patients in the study group and the control group were all without significant difference in the operation of.149 patients. There were 1 cases in the control group with more bleeding after the puncture, and the improvement of the renal fistulae compression hemostasis after the improvement of the patients in the control group. The two stage operation was changed. No kidney loss or death was found after operation. The rate of stone free treatment in the study group and the control group was 64/75 (83.5%) and 54/75 (72%), and the number of patients with complex renal calculi was 20 (68.96%) and 11 (45.83%); the number of blood transfusions after operation was 0 and 4; blood red eggs after operation. The number of white drops was 2 and 9 people more than 30% before operation; the operation time was 83.08 + 28.04min and 92.94 + 28.50min, and the statistical analysis showed that there were statistical differences (P0.05). The average days of hospitalization were 6.64 + 2.66 and 7 + 2.73 in the study group and the control operation. The number of severe bleeding in the operation was 0 and 1. There were no statistically significant differences in the number of renal draining fluid than those of red or severe hematuria in 24h patients (P0.05). There were no significant differences between the 3 groups (9).
[conclusion]:CT urography can clearly understand the anatomy of the renal pyelolithiasis and stones and the relationship between them and the relationship between the two. The best target renal calyx can be accurately positioned for patients with renal calculi with PCNL treatment. Under the monitoring of C arm X-ray, the best choice of.CT urography is to guide the choice of the best. The good target kidney calycalyst is of guiding significance to the puncture target renal calyx and the establishment of the channel, which can improve the stone clearance rate, reduce the postoperative blood transfusion rate, reduce the operation time, reduce the postoperative bleeding related complications and improve the therapeutic effect of PCNL in the treatment of kidney stones. It is worthy of clinical application.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R699.2;R816.7

【共引文獻(xiàn)】

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