Efficacy and safety research of percutaneous nephrolithotomy under color Doppler or type-B ultrasonic guidance
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摘要: 目的 研究肾结石患者进行经皮肾镜取石手术治疗中，采用传统B超和彩色多普勒超声引导2种穿刺引导方式的安全性和有效性比较。方法 选择2021年10月—2023年10月在广水市中医医院接受经皮肾镜取石术治疗的150例患者，根据穿刺引导方式的不同将其分为B超组和彩超组。B超组的穿刺点选择目标肾盏穹隆的中心点，彩超组的穿刺点则是在彩色多普勒血流引导下的肾盏穹隆乏血管区。分析2组之间的手术时间、术后住院日、术后残石率、术前术后血红蛋白(Hb)变化值、术前术后肌酐(Cr)变化值、术中及术后严重出血(输血或介入栓塞)发生率等指标。结果 150例患者中，B超组70例，彩超组80例。彩超组患者的手术时间和术后住院时间显著低于B超组(P < 0.05)；彩超组术后残石率显著低于B超组(P < 0.05)；彩超组术中及术后出血发生率显著低于B超组(P < 0.05)。结论 对比传统B超穿刺方式，采用彩色多普勒超声引导穿刺可以显著提高经皮肾镜取石手术的安全性和有效性。Abstract: Objectives To compare the efficacy and safety between color Doppler and type-B ultrasound guided percutaneous nephrolithotomy (PCNL) in patients with renal calculi.Methods From October 2021 to October 2023, 150 patients who received PCNL in Traditional Chinese Medicine Hospital of Guangshui City were divided into type-B group and color group. The puncture point of the type-B group was the midpoint of the target renal fornix, while the puncture point of the color group was the target renal fornix avascular area pinpointed by color ultrasound. The operative time, postoperative hospital stay, incidence of residual stone, postoperative hemoglobin (Hb) values, serum creatinine (Scr) concentrations and incidence of intraoperative and postoperative bleeding between the two groups were analyzed.Results A total of 150 patients were included in this study, including 70 in type-B group and 80 in color group.Operation time and postoperative hospital stay in color group were significantly shorter than those in type-B group (P < 0.05). The incidence of residual stone in color group was markedly lower than that in type-B group (P < 0.05). The incidence of intraoperative and postoperative bleeding in the color group was signally lower than that in the type-B group (P < 0.05).Conclusion Compared with common type-B ultrasound-guided puncture, color Doppler ultrasound-guided puncture can significantly increase the safety and effectiveness of PCNL.
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Key words:
- percutaneous nephrolithotomy /
- color Doppler ultrasound /
- type-B ultrasound /
- safety /
- effectiveness
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表 1 2组患者术中和术后临床观察指标比较
例(%)，X±S 指标 B超组(70例) 彩超组(80例) P值 Hb术前-术后差值/(g/L) 8.7±8.2 4.1±7.6 < 0.05 Cr术前-术后差值/(μmol/L) 3.1±21.5 3.7±23.3 >0.05 手术时间/min 44.42±12.06 28.95±6.84 < 0.05 术后住院时间/d 10.16±2.21 7.35±1.19 < 0.05 结石清除 51(72.86) 78(97.50) < 0.05 输血或介入栓塞 6(8.57) 1(1.25) < 0.05 
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