体外冲击波碎石对不同部位肾结石非靶区血流量、表面通透性的影响及效果比较
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摘要
目的探讨高能冲击波体外碎石技术治疗对不同部位肾结石患者非靶区血流量、表面通透性的影响及效果。方法选择2015年1月~2017年6月广东省惠州市第一人民医院泌尿外科收治的肾结石患者168例作为研究对象,根据肾结石部位分为肾上盏组(110例)、肾下盏组(58例)。均采用高能量的冲击波(E=12~15 k V)行体外碎石。术前术后对两组非靶区肾脏做CT灌注扫描,比较两组非靶区肾脏的血流量(BF)、表面通透性(PS)变化。比较两组术后并发症发生情况及排石成功率。结果术前术后两组非靶区肾脏CT灌注参数BF、PS组间及组内比较,差异均无统计学意义(P>0.05)。两组术后并发症总发生率比较,差异无统计学意义(P>0.05);但肾上盏组绞痛、发热发生率明显高于肾下盏组,肾下盏组血尿、石街发生率明显高于肾上盏组,差异均有统计学意义(P<0.05)。肾上盏组排石成功率高于肾下盏组,差异有统计学意义(P<0.05)。结论高能量冲击波体外碎石对于不同部位的肾结石患者的非靶区肾脏损伤较为轻微,但肾上盏、肾下盏部位术后并发症情况不同。高能量冲击波体外碎石对于肾上盏区的肾结石的疗效则优于肾下盏区。
Objective To explore the effect of high energy shock wave extracorporeal lithotripsy on patients with different parts of renal calculi. Methods A total of 168 patients with kidney stones in Department of Urology, First People′s Hospital of Huizhou from January 2015 to June 2017 were selected as the research objects and divided into the suprarenal calyx group(110 cases) and inferiorrenal calyx group(58 cases) according to position of the stone. All the patients were treated with high energy shock wave(E = 12-15 k V) for extracorporeal lithotripsy. According to the renal calculi, CT perfusion scanning was performed on the non-target kidneys in both groups before and after surgery. The non-target renal blood flow(BF), surface permeability(PS) changes, postoperative complications and the stone success rate were compared between the two groups. Results There were no statistically significant differences in the CT perfusion parameters of BF and PS in non-target areas between the two groups and within groups(P > 0.05). There was no statistically significant difference in the total incidence of complications between the two groups(P > 0.05). However,the incidence of colic and fever in the suprarenal calyx group were significantly higher than those of inferiorrenal calyx group, and the incidence of hematuria and stone streets in inferiorrenal calyx group were significantly higher than those of suprarenal calyx group, with statistically significant differences(P < 0.05). The success rate of stone in the suprarenal calyx group was higher than that of inferiorrenal calyx group, with statistically significant differences(P <0.05). Conclusion High energy shock wave extracorporeal lithotripsy has less damage to non-target kidney in patients with different parts of renal calculus, but there are different postoperative complications in suprarenal renal calyx and inferiorrenal calyx. The effect of high energy shock wave extracorporeal lithotripsy in stone of suprarenal calyx is better than that of inferiorrenal calyx.
Objective To explore the effect of high energy shock wave extracorporeal lithotripsy on patients with different parts of renal calculi. Methods A total of 168 patients with kidney stones in Department of Urology, First People′s Hospital of Huizhou from January 2015 to June 2017 were selected as the research objects and divided into the suprarenal calyx group(110 cases) and inferiorrenal calyx group(58 cases) according to position of the stone. All the patients were treated with high energy shock wave(E = 12-15 k V) for extracorporeal lithotripsy. According to the renal calculi, CT perfusion scanning was performed on the non-target kidneys in both groups before and after surgery. The non-target renal blood flow(BF), surface permeability(PS) changes, postoperative complications and the stone success rate were compared between the two groups. Results There were no statistically significant differences in the CT perfusion parameters of BF and PS in non-target areas between the two groups and within groups(P > 0.05). There was no statistically significant difference in the total incidence of complications between the two groups(P > 0.05). However,the incidence of colic and fever in the suprarenal calyx group were significantly higher than those of inferiorrenal calyx group, and the incidence of hematuria and stone streets in inferiorrenal calyx group were significantly higher than those of suprarenal calyx group, with statistically significant differences(P < 0.05). The success rate of stone in the suprarenal calyx group was higher than that of inferiorrenal calyx group, with statistically significant differences(P <0.05). Conclusion High energy shock wave extracorporeal lithotripsy has less damage to non-target kidney in patients with different parts of renal calculus, but there are different postoperative complications in suprarenal renal calyx and inferiorrenal calyx. The effect of high energy shock wave extracorporeal lithotripsy in stone of suprarenal calyx is better than that of inferiorrenal calyx.
引文
[1]刘亚玮,李建坤,赵春艳,等.体外震波碎石术后应用中药排石汤治疗肾结石患者的疗效观察[J].中国药房,2016,27(8):1110-1112.
[2]杨丽珠,郭晓健,梁丽莉,等.体外冲击波碎石术治疗马蹄肾结石的临床疗效[J].中华泌尿外科杂志,2016,37(3):206-208.
[3]叶绪晓.体外冲击波碎石治疗输尿管结石疗效的相关影响因素[J].实用临床医药杂志,2015,19(11):105-106.
[4]吴爱斌,秦锁炳,卜强.输尿管软镜联合体外冲击波碎石在肾结石治疗中的应用价值研究[J].临床研究,2016,24(12):59-60.
[5]马小兵,佘金燕.金沙疏通颗粒结合体外冲击波碎石治疗肾结石的临床研究[J].世界最新医学信息文摘:连续型电子期刊,2016,16(8):156-157.
[6]郑铎,田彦.经皮肾镜取石术在多次体外冲击波碎石失败肾结石患者中的应用探讨[J].中国医药指南,2017,15(15):98-99.
[7]孙功喜.体外冲击波碎石治疗输尿管结石并发症原因分析及防治策略[J].中国卫生标准管理,2018(6):40-42.
[8]李文峰,潘惟昕,陆超,等.肾结石体外冲击波碎石失败短期内行输尿管软镜治疗的疗效分析[J].现代泌尿外科杂志,2017,22(6):437-439.
[9]相聪坤.八正散加味结合甲磺酸左氧氟沙星对肾结石体外冲击波碎石术后肾组织损伤的影响[J].国际中医中药杂志,2016,38(3):216-219.
[10]张舰,李成英,姜源洁.体外冲击波碎石联合中药辅助排石治疗肾结石的效果[J].贵阳医学院学报,2017,42(5):600-603.
[10]陈兴发.EAU2013版结石诊疗指南新意解读[J].现代泌尿外科杂志,2014,19(3):145-148.
[10]葛广成,崔飞伦,李中兴,等.体外冲击波碎石和输尿管软镜在治疗2 cm以下肾下盏结石的前瞻性随机对照研究[J].现代泌尿外科杂志,2016,21(7):533-536.
[13]翟春雷,蒋雷鸣.不同治疗方案对于临界性肾结石的疗效对比分析[J].中国医药指南,2016,14(6):18-19.
[14]王宏.能谱CT结石成分分析技术在肾结石低能量体外冲击波碎石术中的临床应用[J].影像技术,2017,29(1):51-52.
[15]彭可,姜宁,王国增,等.上段输尿管结石经输尿管镜钬激光与经体外震波碎石术后对肾脏损伤的比较研究[J].宁夏医科大学学报,2015,37(1):33-35.
[16]符红霞,魏展州,黎国新.体外冲击波碎石对不同部位肾结石非靶区的影响及观察[J].实用医学杂志,2017,33(11):1795-1798.
[17]孙柳静,朱喜山,王科峰.输尿管镜下U100~(plus)激光碎石术和体外冲击波碎石术治疗输尿管结石的疗效比较[J].实用临床医药杂志,2015,19(19):104-105.
[18]张林,刘同族,王行环,等.输尿管软镜碎石取石术辅以体外冲击波碎石术治疗2 cm以下孤立肾结石的临床观察[J].现代泌尿外科杂志,2015,20(8):577-579.
[19]郝继东,廖国强,刘辉,等.经皮肾镜钬激光碎石术与体外冲击波碎石术治疗肾结石的效果[J].河北医学,2016,22(1):20-23.
[20]蔡雪霞.护理延伸服务对尿路结石患者体外冲击波碎石疗效的影响[J].解放军护理杂志,2015,23(1):119-120.
[21]唐霞燕.上尿路结石患者行ESWL治疗后并发症及预防措施[J].中国现代医生,2017,55(18):91-94,98.
[22]张鑫琦,耿丽聪,黄忠.输尿管镜下钬激光碎石术与体外冲击波碎石术治疗输尿管结石的疗效比较[J].中国现代医生,2017,55(12):38-40.
[23]韩东江,田凤,彭仁德.体外冲击波碎石结合中西医药物综合治疗泌尿系结石的临床研究[J].中外医学研究,2017,13(1):14-15.
[2]杨丽珠,郭晓健,梁丽莉,等.体外冲击波碎石术治疗马蹄肾结石的临床疗效[J].中华泌尿外科杂志,2016,37(3):206-208.
[3]叶绪晓.体外冲击波碎石治疗输尿管结石疗效的相关影响因素[J].实用临床医药杂志,2015,19(11):105-106.
[4]吴爱斌,秦锁炳,卜强.输尿管软镜联合体外冲击波碎石在肾结石治疗中的应用价值研究[J].临床研究,2016,24(12):59-60.
[5]马小兵,佘金燕.金沙疏通颗粒结合体外冲击波碎石治疗肾结石的临床研究[J].世界最新医学信息文摘:连续型电子期刊,2016,16(8):156-157.
[6]郑铎,田彦.经皮肾镜取石术在多次体外冲击波碎石失败肾结石患者中的应用探讨[J].中国医药指南,2017,15(15):98-99.
[7]孙功喜.体外冲击波碎石治疗输尿管结石并发症原因分析及防治策略[J].中国卫生标准管理,2018(6):40-42.
[8]李文峰,潘惟昕,陆超,等.肾结石体外冲击波碎石失败短期内行输尿管软镜治疗的疗效分析[J].现代泌尿外科杂志,2017,22(6):437-439.
[9]相聪坤.八正散加味结合甲磺酸左氧氟沙星对肾结石体外冲击波碎石术后肾组织损伤的影响[J].国际中医中药杂志,2016,38(3):216-219.
[10]张舰,李成英,姜源洁.体外冲击波碎石联合中药辅助排石治疗肾结石的效果[J].贵阳医学院学报,2017,42(5):600-603.
[10]陈兴发.EAU2013版结石诊疗指南新意解读[J].现代泌尿外科杂志,2014,19(3):145-148.
[10]葛广成,崔飞伦,李中兴,等.体外冲击波碎石和输尿管软镜在治疗2 cm以下肾下盏结石的前瞻性随机对照研究[J].现代泌尿外科杂志,2016,21(7):533-536.
[13]翟春雷,蒋雷鸣.不同治疗方案对于临界性肾结石的疗效对比分析[J].中国医药指南,2016,14(6):18-19.
[14]王宏.能谱CT结石成分分析技术在肾结石低能量体外冲击波碎石术中的临床应用[J].影像技术,2017,29(1):51-52.
[15]彭可,姜宁,王国增,等.上段输尿管结石经输尿管镜钬激光与经体外震波碎石术后对肾脏损伤的比较研究[J].宁夏医科大学学报,2015,37(1):33-35.
[16]符红霞,魏展州,黎国新.体外冲击波碎石对不同部位肾结石非靶区的影响及观察[J].实用医学杂志,2017,33(11):1795-1798.
[17]孙柳静,朱喜山,王科峰.输尿管镜下U100~(plus)激光碎石术和体外冲击波碎石术治疗输尿管结石的疗效比较[J].实用临床医药杂志,2015,19(19):104-105.
[18]张林,刘同族,王行环,等.输尿管软镜碎石取石术辅以体外冲击波碎石术治疗2 cm以下孤立肾结石的临床观察[J].现代泌尿外科杂志,2015,20(8):577-579.
[19]郝继东,廖国强,刘辉,等.经皮肾镜钬激光碎石术与体外冲击波碎石术治疗肾结石的效果[J].河北医学,2016,22(1):20-23.
[20]蔡雪霞.护理延伸服务对尿路结石患者体外冲击波碎石疗效的影响[J].解放军护理杂志,2015,23(1):119-120.
[21]唐霞燕.上尿路结石患者行ESWL治疗后并发症及预防措施[J].中国现代医生,2017,55(18):91-94,98.
[22]张鑫琦,耿丽聪,黄忠.输尿管镜下钬激光碎石术与体外冲击波碎石术治疗输尿管结石的疗效比较[J].中国现代医生,2017,55(12):38-40.
[23]韩东江,田凤,彭仁德.体外冲击波碎石结合中西医药物综合治疗泌尿系结石的临床研究[J].中外医学研究,2017,13(1):14-15.