B超引导下标准通道经皮肾镜取石术联合超声气压弹道碎石术治疗上尿路结石疗效研究  

Research on the curative effect of standard channel PCNL combined with ultrasonic pneumatic lithotripsy in the treatment of upper urinary tract calculi under the guidance of ultrasound

作　　者：巴达仁贵 姜海山[2] BA Da-rengui;JIANG Hai-shan(Department of Urinary Surgery, The First Hospital of Hohhot in Inner Mongolia, Hohhot 010020, China)

机构地区：[1]呼和浩特市第一医院泌尿外科,内蒙古呼和浩特010020 [2]包头市第四医院普外科,内蒙古包头014030

出　　处：《中国医学装备》2017年第12期78-81,共4页China Medical Equipment

基　　金：包头市科技局社会发展科技支撑项目(2015S2006-3-7)"PCNL联合超声气压弹道碎石术治疗上尿路结石疗效分析"

摘　　要：目的:研究B超引导下标准通道经皮肾镜取石术(PCNL)联合超声气压弹道碎石术对上尿路结石的临床疗效,并分析术后结石残留的影响因素。方法:回顾性分析医院收治的94例上尿路结石患者资料。所有患者均行B超引导下标准通道PCNL联合超声气压弹道碎石术治疗,观察输尿管上段结石、肾盂结石、肾多发结石、肾结石伴输尿管上段结石和鹿角形结石5种不同类型结石的手术治疗结果,监测术后并发症发生情况,了解残留结石情况,计算结石清除率。分析残留结石患者和未残留结石患者一般资料差异情况,采用Logistic回归方程分析结石残留的影响因素。结果:术后并发症发生率为27.66%,结石清除率67.02%,结石残留率32.98%。5种不同类型结石患者在定位穿刺时间、建立通道时间及拔造瘘管时间的差异均无统计学意义(F=1.89,F=2.46,F=0.91;P>0.05);而在碎石取石时间、术中出血量以及住院时间上差异均有统计学意义(F=81.90,F=35.84,F=4.17;P<0.05)。根据Logistic回归方程计算,结石类型、结石大小、肾积水、尿路感染以及肾功能不全均为上尿路结石患者PCNL联合超声气压弹道术治疗术后结石残留的影响因素。结论:B超引导下进行PCNL联合超声气压弹道碎石术疗效较好,无重大并发症发生,且结石清除率较高。而结石类型、结石大小、肾积水、尿路感染以及肾功能不全均会导致术后结石残留发生率增加,影响治疗效果。Objective:To study the curative effect of standard channel(percutaneous nephrolithotomy)PCNL combined with ultrasonic pneumatic lithotripsy in the treatment of upper urinary tract calculi under the guidance of ultrasound,and analyze the influence factors of post-operative residual calculi.Methods:The data of94patients with upper urinary tract calculi were researched by using retrospective analysis.All of patients underwent the treatment of standard channel PCNL combined with ultrasonic pneumatic lithotripsy for upper urinary tract calculi under the guidance of ultrasound.The curative effects of upper ureteral calculi,pelvis calculi,multiple renal calculi,kidney stone with ureteral calculi and renal staghorn calculi were observed,and the post-operative complications were further detected so as to grasp the situation of residual calculi and calculate the clearance rate of calculus.The difference of general documents between patients with residual calculi and those without residual calculi were compared,and the influence factors of residual calculi were analyzed by using Logistic regression equation.Results:The incidence of post-operative complication was27.66%,the clearance rate of calculus was67.2%and residual rate of calculus was32.98%.The differences of location puncture time,establishing channel time and ostomy fistula time among the five kinds of patients were no significant(F=1.89,F=2.46,F=0.91,P>0.05).While the differences of calculus removed time,amount of bleeding in intra-operative period and length of stay among various kinds of patients were significant(F=81.90,F=35.84,F=4.17,P<0.05).Depended on the results of Logistic regression equation,the types of calculus,size of calculus,hydronephrosis,urinary tract infection and renal insufficiency were the influence factors of postoperative residual calculus of patients with upper urinary tract calculi who received the treatment of PCNL combined with ultrasonic pneumatic lithotripsy.Conclusion:PCNL combined with ultrasound pneumatic lithotripsy under the guidanc

关 键 词：B超引导 经皮肾镜取石术 超声气压弹道碎石术 上尿路结石 残留结石 

分 类 号：R445.1[医药卫生—影像医学与核医学]