Significance of color Doppler ultrasound guidance for reducing bleeding and postoperative hospital stay during percutaneous nephrolithotomy
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摘要: 目的 探究B超联合彩色多普勒超声引导穿刺在降低经皮肾镜取石术(percutaneous nephrolithotomy，PCNL)术出血以及术后住院天数的意义。方法 回顾性分析2021年6月—2023年6月上海交通大学医学院附属同仁医院收治的120例肾结石和或输尿管上段结石行PCNL的患者临床资料。根据引导穿刺方式的不同，分为单纯B超灰阶扫描引导穿刺组(B超组)及B超联合彩色多普勒引导穿刺组(彩超组)，比较2组的临床资料以及手术并发症，尤其是手术出血和术后住院天数。结果 B超组和彩超组患者的年龄[(54.110±11.218)岁vs (53.001±12.575)岁]、结石大小[(622.074±59.433) mm2 vs (678.125±52.834) mm2]、手术时间[(87.483±21.558) min vs (86.217±24.399) min]、手术通道[(1.150±0.360)个vs (1.183±0.390)个]、术前血红蛋白[(136.651±15.713) g/L vs (135.301±13.982) g/L]及术后血红蛋白[(123.533±14.623) g/L vs (126.166±13.176) g/L]比较差异均无统计学意义(P>0.05)。在术后住院天数[(7.250±1.997) d vs (6.150±1.176) d]和血红蛋白下降[(13.117±9.106) g/L vs (9.133±6.588) g/L]比较中，2组差异有统计学意义(P < 0.05)。结论 B超联合彩色多普勒引导穿刺可实时监视并避开肾脏较大的血管，可明显降低PCNL出血以及术后住院天数。Abstract: Objective To explore the significance of B-ultrasonography combined with color Doppler ultrasonic-guided puncture for reducing bleeding and postoperative hospital stay in percutaneous nephrolithotomy(PCNL).Methods The clinical data of 120 patients with renal calculi and/or upper ureteral calculi who underwent PCNL from June 2021 to June 2023 in Tongren Hospital, Shanghai Jiao Tong University School of Medicinewere retrospectively analyzed. According to the different guiding puncture methods, they were divided into a simple B-ultrasound gray-scale scan-guided puncture group and B-ultrasound combined with color Doppler-guided puncture group. Surgical complications, especially surgical bleeding and postoperative hospital stay were compared between the two groups.Results There was no significant difference between the two groups(P>0.05) in age([54.110±11.218]years vs [53.001±12.575]years), stone size([622.074±59.433]mm2 vs [678.125±52.834]mm2), operation time([87.483±21.558]min vs [86.217±24.399]min), operation channel([1.150±0.360]vs [1.183±0.390]), preoperative hemoglobin([136.651±15.713]g/L vs [135.301±13.982]g/L) or postoperative hemoglobin([123.533±14.623]g/L vs [126.166±13.176]g/L). In the comparison of postoperative hospital stay([7.250±1.997]days vs [6.150±1.176]days) and hemoglobin decrease([13.117±9.106]g/L vs [9.133±6.588]g/L), there were statistical significant differences between the two groups(P < 0.05).Conclusion B-ultrasound combined with color Doppler guided puncture can monitor and avoid large blood vessels in the kidney in real time, so it can significantly reduce PCNL bleeding and postoperative hospitalization days.
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Key words:
- percutaneous nephrolithotomy /
- color Doppler ultrasound /
- urinary calculi
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表 2 2组观察指标比较
X±S 指标 B超组(60例) 彩超组(60例) t P值 年龄/岁 54.110±11.218 53.001±12.575 0.506 0.305 结石大小/mm2 622.074±59.433 678.125±52.834 -0.213 0.642 手术时间/min 87.483±21.558 86.217±24.399 0.301 0.256 手术通道/个 1.150±0.360 1.183±0.390 -0.468 0.331 术后住院天数/d 7.250±1.997 6.150±1.176 3.676 0.038 术前血红蛋白/(g/L) 136.651±15.713 135.301±13.982 0.497 0.529 术后血红蛋白/(g/L) 123.533±14.623 126.166±13.176 -1.036 0.419 血红蛋白下降/(g/L) 13.117±9.106 9.133±6.588 2.745 0.016 
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