B超聯合C型臂X光機在經皮腎鏡碎石術中建立經皮腎鏡工作通道的臨床應用

李四化　范翰共　劉聰

【摘要】 目的：探討B超X線聯合引導下經皮腎鏡治療上尿路結石在基層醫院應用的可行性、療效，為基層醫院實行PCNL的選擇提供參考。方法：選取2014年3月-2017年3月本院收治44例上尿路結石并接受經皮腎鏡碎石術治療的患者隨機分為研究組共23例和對照組共21例，研究組采用B超X線聯合引導下進行定位及穿刺，而對照組只采用B超引導下穿刺。兩組患者的觀察指標包括平均手術時間、術后住院時間、手術前后血紅蛋白變化量，以及術中或術后輸血、感染情況；此外，還進行一、二、三期取石率和殘石率的統計。結果：研究組的手術時間和術后住院時間明顯比對照組短，比較差異均有統計學意義（P<0.05）；研究組的手術前后血紅蛋白變化量也比對照組少（P<0.05）；術中或術后輸血率明顯比對照組低（P<0.05）。研究組的一期取石率明顯比對照組的高，比較差異有統計學意義（P<0.05）；二期取石率雖然也高于對照組，但比較差異無統計學意義（P>0.05）；研究組的殘留結石率明顯比對照組低（P<0.05）。結論：B超和X線聯合定位引導下PCNL治療上尿路結石，能有效結合B超和X線兩種定位方法的優點，并避免兩者的缺點，對提高手術安全性、一期手術結石的清除率、減少住院時間和費用有很大幫助，值得在基層醫院推廣。

【關鍵詞】 上尿路結石； B超； X線； 經皮腎穿刺取石； 基層醫院

The Clinical Feasibility and Effect of Ultrasound and X-ray Guidance for Percutaneous Nephrolithotomy Treating Renal Calculi/LI Si-hua，FAN Han-gong，LIU Cong.//Medical Innovation of China，2017，14（22）：021-024

【Abstract】 Objective：To explore the feasibility and effect of ultrasound and X-ray guidance for percutaneous nephrolithotomy treating upper urinary calculi，in order to providing reference for primary hospitals.Method：From March 2014 to March 2017 in our hospital，44 patients with renal calculi who were performed percutaneous nephrolithotomy were collected and divided into the observation group （B-type ultrasound+ X-ray group） of 23 cases and control group （B-type ultrasound） of 21 cases.The average operation time，postoperative hospital stay，hemoglobin variation before and after operation，intraoperative and postoperative blood transfusion and infection of two groups were analyzed.In addition，the stone-free rate and residual stone rate of two groups of patients at first， second and third phase were recorded.Result：The operation time and postoperative hospital stay in observation group were significantly shorter than that in the control group，the difference was statistical significance（P<0.05）.The hemoglobin variation before and after operation in observation group was less than that the control group（P<0.05）.The intraoperative and postoperative blood transfusion rate in observation group were obviously lower than those of control group（P<0.05）.The first phase of stone-free rate in observation group was significantly higher than that of control group（P<0.05）.Though the second phase of stone-free rate in observation group was higher than that of control group，the difference was not statistically significant（P>0.05）.Team residual stone rate in observation group was obviously lower than that of the control group（P<0.05）.Conclusion：The ultrasound combined X-ray was useful for the percutaneous nephrolithotomy treating upper urinary calculi，which collecting each other advantage，can improve the operation safety and stone clearance rate，reduce the length of hospital stay and cost，it is worth popularizing in primary hospitals.endprint

【Key words】 Upper urinary calculi； Ultrasound； X-ray； Percutaneous Nephrolithotomy； Primary hospital

First-authors address：Yi-hui Fund Hospital of Shanwei City，Shanwei 516600，China

doi：10.3969/j.issn.1674-4985.2017.22.006

上尿路結石包括腎結石和輸尿管上段結石，是我國大多數基層醫院的常見病，可導致嚴重并發癥，影響患者的身心健康與日常生活。近年來，微創技術蓬勃發展，腔內微創手術因其效果好、操作簡單、創傷小的特點，逐漸取代傳統開放手術，其中經皮腎鏡取石術（percutaneous nephrolithotomy，PCNL）已成為目前各大醫院治療復雜腎結石的首選方法[1-2]。現在應如何安全有效地建立經皮腎穿刺通道，是手術醫生進行PCNL手術的關鍵點及難點[3]。工作通道的建立通常采用C型臂X光機線或B超定位，傳統的單一超聲或C型臂X光機引導定位，各有其優缺點[4]。本文采用B超聯合C型臂X光機在經皮腎鏡碎石術中建立經皮腎鏡工作通道的臨床應用中，取得了良好效果，現報道如下。……