摘要
目的探讨改良Valdivia体位与俯卧位经皮肾镜取石术(PCNL)对肾结石的清除效果及安全性。方法回顾性分析咸阳市第一人民医院2015年9月到2016年11月收治的94例肾结石患者的临床资料,按手术方法及体位的不同将其分为对照组和观察组,每组47例。对照组患者行俯卧位PCNL,观察组行改良Valdivia体位PCNL。比较2组患者手术情况、术后情况、结石清除率及不良反应发生率,同时观察2组患者体位安置前后的舒张压(DBP)、收缩压(SBP)及心率(HR)等指标水平。结果体位安置后,2组患者DBP和SBP水平均下降,观察组下降幅度低于对照组,2组比较差异有极显著性统计学意义(P<0.01),而2组HR比较差异无统计学意义(P>0.05);观察组患者的手术时间、术中出血量、住院时间、再次手术率及输血率均明显低于对照组,2组比较差异有统计学意义(P<0.05),结石清除率显著高于对照组(χ~2=9.55,P=0.00);观察组患者胸闷、躁动发生率均明显低于对照组(P<0.05),感染、出血、胸膜损伤及肾损伤发生率均略低于对照组,但组间差异无统计学意义(P>0.05)。结论肾结石患者采用改良Valdivia体位PCNL缩短了手术时间,能够有效清除结石,疗效显著且治疗安全性高。
Objective To study the effect and safety of modified Valdivia position and prone position in percutaneous nephrolithotomy （PCNL） on renal calculi. Methods The clinical data of 94 patients with solitary renal calculi admitted in our hospital from September 2015 to November 2016 were enrolled to this study,who were divided into control group and study group by surgery methods and body position,47 cases in each group. The control group received PCNL with prone position,and the study group were treated by PCNL with modified Valdivia position. The operative condition, postoperative condition, stone clearance rate and incidence of adverse reactions between the two groups between two groups were compared, and the levels of diastolic blood pressure （DBP） , systolic blood pressure （SBP） and heart rate （HR） between the two groups were observed. Results After position placement, DBP and SBP level decreased in both groups, the level of DBP and SBP in study group were lower than the control group, the difference was significant（ P 〈 0.01 ）. There was no significant difference in the lev- el of HR between two groups （P 〉 0.05 ）. The operative time, intraoperative blood loss, hospitalization time, reoperation rate and blood transfu- sion rate in the study group were lower than those in control group, the differences were significant （ P 〈 0.05 ）, the removal rate of stones was significantly higher than that of control group （χ^2 = 9.55, P = 0.00 ）. The rate of chest stuffy and dysphoria in the study group were higher than those in control group（ P 〈 0.05 ）. The incidence of infection,hemorrhage, pleural injury and renal injury were slightly lower than those of the control group, but there was no significant difference between two groups （ P 〉 0.05 ）. Conclusion PCNL with modified Valdivia position has high safety and significant effect on patients with kidney stones, which can effectively remove stones, reduce operation time.
出处
《局解手术学杂志》
2017年第9期690-693,共4页
Journal of Regional Anatomy and Operative Surgery
