X线与超声在经皮肾镜治疗复杂性肾结石中的应用比较
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摘要
目的对比分析C臂X线和超声定位在微创经皮肾镜碎石取石术(PCNL)治疗复杂性肾结石中的优劣性。方法回顾性分析我科2015年7月至2017年7月156例行MPCNL的复杂性肾结石患者(89例在C臂X线引导下,67例在超声引导下)的临床资料,对患者首次目标盏穿刺成功率,两组手术后血红蛋白下降值、结石Ⅰ期取净率、手术并发症等进行分析比较。结果 X线组89例患者,首次目标盏穿刺成功69例,手术后血红蛋白下降值为(16.2±7.4)g/L,结石Ⅰ期取净62例,发生手术并发症12例,超声组67例患者,首次目标盏穿刺成功31例,手术前血红蛋白下降值为(19.5±8.2)g/L,结石Ⅰ期取净42例,发生手术并发症10例。两组患者在首次目标盏穿刺成功率、手术后血红蛋白下降值的差异均有统计学意义(P<0.05);结石Ⅰ期取净率及手术并发症的差异无统计学意义(P<0.05)。结论在MPCNL治疗复杂性肾结石中,X线引导相对于超声能明显提高首次目标盏穿刺成功率,减少术中出血,是治疗复杂性肾结石的较好方法。医师应根据其医疗设备、手术技能和临床经验的特点,为患者制定最优穿刺定位方案。
Objective To compare the application value between C-arm X-ray and ultrasound localization in the minimally invasive percutaneous nephrolithotomy(MPCNL) for complicated renal calculi. Methods Clinical data of 156 patients with complicated renal calculi admitted to our department from July 2015 to July 2017 were retrospectively analyzed. Among them, 89 patients underwent C-arm X-ray-guided MPCNL and 67 cases received ultrasound-guided MPCNL. The success rate of the first caliceal puncture, postoperative decline in hemoglobin level, stage I removal rate of renal calculi and surgical complications were analyzed. Results In the X-ray group, the first caliceal puncture was successfully performed for 69 patients, the hemoglobin level was decreased(16.2±7.4) g/L after operation,the stage I removal rate of renal calculi was 69.66%(62/89), and surgical complications occurred in12 cases. In the ultrasound group, the first caliceal puncture was successfully performed for 31 patients,the hemoglobin level was declined(19.5±8.2) g/L postoperatively, the stage I removal rate of renal calculi was 62.69%(42/67), and surgical complications were found in 10 cases. The success rate of the first caliceal puncture and postoperative decline in hemoglobin level showed statistical difference between the two groups(both P<0.05). The stage I removal rate of renal calculi and surgical complications showed no statistical difference between the two groups(both P>0.05). Conclusion During MPCNL in the treatment of complicated renal calculi, X-ray guidance can significantly improve the success rate of the first caliceal puncture and minimize intraoperative hemorrhage while compared with ultrasound, which is an efficacious management of complicated renal calculi. Surgeons should adopt the optimal puncture approach for different patients according to the characteristics of medical equipment, surgical skills, and clinical experience.
Objective To compare the application value between C-arm X-ray and ultrasound localization in the minimally invasive percutaneous nephrolithotomy(MPCNL) for complicated renal calculi. Methods Clinical data of 156 patients with complicated renal calculi admitted to our department from July 2015 to July 2017 were retrospectively analyzed. Among them, 89 patients underwent C-arm X-ray-guided MPCNL and 67 cases received ultrasound-guided MPCNL. The success rate of the first caliceal puncture, postoperative decline in hemoglobin level, stage I removal rate of renal calculi and surgical complications were analyzed. Results In the X-ray group, the first caliceal puncture was successfully performed for 69 patients, the hemoglobin level was decreased(16.2±7.4) g/L after operation,the stage I removal rate of renal calculi was 69.66%(62/89), and surgical complications occurred in12 cases. In the ultrasound group, the first caliceal puncture was successfully performed for 31 patients,the hemoglobin level was declined(19.5±8.2) g/L postoperatively, the stage I removal rate of renal calculi was 62.69%(42/67), and surgical complications were found in 10 cases. The success rate of the first caliceal puncture and postoperative decline in hemoglobin level showed statistical difference between the two groups(both P<0.05). The stage I removal rate of renal calculi and surgical complications showed no statistical difference between the two groups(both P>0.05). Conclusion During MPCNL in the treatment of complicated renal calculi, X-ray guidance can significantly improve the success rate of the first caliceal puncture and minimize intraoperative hemorrhage while compared with ultrasound, which is an efficacious management of complicated renal calculi. Surgeons should adopt the optimal puncture approach for different patients according to the characteristics of medical equipment, surgical skills, and clinical experience.
引文
[1]李响,王平,刘屹立.经皮肾镜取石术后严重出血行选择性肾动脉栓塞11例临床分析[J].临床泌尿外科杂志,2014,29(10):903-905.
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[5]钟煜韡,刘继普,郑永宏,等.CT平扫轴向旋转视频显像在复杂性肾结石经皮肾镜取石术中的应用[J].现代泌尿外科杂志,2015,20(5):332-335.
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[9]Okhunov z,Friedlander ji,George.S.T.O.N.E.nephrolithometry:novel surgical classificatney calculi[J].Urology,2013,81(6):1154-1159.
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[11]阮黎,李正明,李刚,等.超声和X线引导下经皮肾镜取石术的临床差异[J/CD].中华腔镜泌尿外科杂志(电子版),2014,8(5):338-340.
[12]蔡治涛,刘宏,吴雄飞.C臂X线机联合超声在经皮肾镜碎石术治疗复杂肾结石中的临床价值[J].临床泌尿外科杂志,2014,29(3):240-244.
[13]陈细明,王海坤,廖贤平.B超联合X线引导定位下微创经皮肾镜治疗复杂性肾结石的体会[J].中国社区医师(医学专业),2012,14(24):161.
[14]阮黎,吴喜链,董忠,等.普通超声定位经皮肾镜取石术开展早期的病例分析与经验总结[J/CD].中华腔镜泌尿外科杂志(电子版),2017,11(4):250-254.
[15]汪海龙,张宗平,王安果,等.瞬时X线定位联合术中逆行造影在经皮肾镜取石术的临床价值[J].临床泌尿外科杂志,2016,31(7):601-609.
[16]陈延雄,司徒杰,狄金明,等.便携式无线超声在经皮肾镜术中的初步应用[J/CD].中华腔镜泌尿外科杂志(电子版),2017,11(3):190-194.
[2]谢圣陶,陈广瑜.经皮肾镜取石术后并发重症感染的原因探讨及防治[J].临床泌尿外科杂志,2014,29(9):808-810.
[3]邢刚,邓国卫,阮黎,等.组合式输尿管硬镜联合软镜与经皮肾镜治疗肾盂结石的比较[J/CD].中华腔镜泌尿外科杂志(电子版),2018,12(1):24-27.
[4]那彦群,叶章群,孙颖浩主编.中国泌尿外科疾病诊断治疗指南[M].人民卫生出版社,2014:139-140.
[5]钟煜韡,刘继普,郑永宏,等.CT平扫轴向旋转视频显像在复杂性肾结石经皮肾镜取石术中的应用[J].现代泌尿外科杂志,2015,20(5):332-335.
[6]李应龙,丁国富,王勤章,等.微创经皮肾镜联合膀胱软镜治疗复杂性肾结石的疗效观察[J/CD].中华腔镜泌尿外科杂志(电子版),2015,9(1):30-33.
[7]Kupajski M,Tkocz M,Ziaja D.Modern management of stone disease in patients with a solitary kidney[J].Wideochir Inne TechMalo Inwazyjne,2012,7(1):1-7.
[8]梁东彦,李巧星,邵军,等.影响微创经皮肾取石术清石效果的相关因素分析[J].临床泌尿外科杂志,2016,31(7):610-615.
[9]Okhunov z,Friedlander ji,George.S.T.O.N.E.nephrolithometry:novel surgical classificatney calculi[J].Urology,2013,81(6):1154-1159.
[10]Alanc C,Kocoglu H,Ates F,et al,Ultrasound-guided X-ray free percutaneous nephrolithotomy for treatment of simple stones in the flank po sition[J].Urol res,2011,39(3):205-212.
[11]阮黎,李正明,李刚,等.超声和X线引导下经皮肾镜取石术的临床差异[J/CD].中华腔镜泌尿外科杂志(电子版),2014,8(5):338-340.
[12]蔡治涛,刘宏,吴雄飞.C臂X线机联合超声在经皮肾镜碎石术治疗复杂肾结石中的临床价值[J].临床泌尿外科杂志,2014,29(3):240-244.
[13]陈细明,王海坤,廖贤平.B超联合X线引导定位下微创经皮肾镜治疗复杂性肾结石的体会[J].中国社区医师(医学专业),2012,14(24):161.
[14]阮黎,吴喜链,董忠,等.普通超声定位经皮肾镜取石术开展早期的病例分析与经验总结[J/CD].中华腔镜泌尿外科杂志(电子版),2017,11(4):250-254.
[15]汪海龙,张宗平,王安果,等.瞬时X线定位联合术中逆行造影在经皮肾镜取石术的临床价值[J].临床泌尿外科杂志,2016,31(7):601-609.
[16]陈延雄,司徒杰,狄金明,等.便携式无线超声在经皮肾镜术中的初步应用[J/CD].中华腔镜泌尿外科杂志(电子版),2017,11(3):190-194.