CAJ | 학술논문

目的探讨一种经济简单有效的措施,能保障上尿路结石合并肾积脓患者行一期mPCNL的安全性,尽量减少手术次数,减轻患者的负担.方法 2011年12月～2013年5月间,前瞻性收集在中南大学湘雅医院泌尿外科应用mPCNL一期治疗上尿路结石且符合入选标准的患者资料进行分组对照研究.将病例分为实验组:合并脓肾术中予以稀释络合碘冲洗者;对照组:同期非脓肾患者.比较两组患者的术后发热情况(血常规、发热程度、发热天数)、冲洗后穿刺液培养结果、术后住院时间等,重点比较术后发热情况及穿刺液培养结果.数据采用SPSS19.0进行统计分析.结果本课题选取的51例患者均行mPCNL顺利完成了手术,其中22例为术中穿刺确诊为脓肾的患者,予稀释的络合碘冲洗后行一期碎石取石,对照组有29例.实验组穿刺液冲洗前后细菌培养结果经x2检验,P ＜0.05,差异有统计学意义,冲洗前后存在明显差异;实验组术后平均发热天数为1.52 ±0.59d,对照组术后平均发热天数为1.00±1.01d,采用单因素方差分析,P ＞0.05,无明显差异;实验组术后白细胞为9.05±2.95(×109/L),对照组术后白细胞为8.68±2.81(×109/L),采用单因素方差分析,P＞0.05,无明显差异;实验组术后中性比为83.65±9.83％,对照组术后中性比为86.04 ±7.87％,采用单因素方差分析,P＞0.05,二者无明显差异;实验组术后平均住院时间8.84±0.37d,对照组术后平均住院时间8.14±1.82d,采用单因素方差分析,P＞0.05,二者无明显差异.结论对于术中穿刺确诊为脓肾的患者,采用稀释络合碘冲洗后一期行经皮肾镜碎石取石术经疗效分析是安全的、可靠的,术后并发症少,恢复快,临床证实有效.
목적 탐토일충경제간단유효적조시,능보장상뇨로결석합병신적농환자행일기mPCNL적안전성,진량감소수술차수,감경환자적부담.방법 2011년12월～2013년5월간,전첨성수집재중남대학상아의원비뇨외과응용mPCNL일기치료상뇨로결석차부합입선표준적환자자료진행분조대조연구.장병례분위실험조:합병농신술중여이희석락합전충세자;대조조:동기비농신환자.비교량조환자적술후발열정황(혈상규、발열정도、발열천수)、충세후천자액배양결과、술후주원시간등,중점비교술후발열정황급천자액배양결과.수거채용SPSS19.0진행통계분석.결과 본과제선취적51례환자균행mPCNL순리완성료수술,기중22례위술중천자학진위농신적환자,여희석적락합전충세후행일기쇄석취석,대조조유29례.실험조천자액충세전후세균배양결과경x2검험,P ＜0.05,차이유통계학의의,충세전후존재명현차이;실험조술후평균발열천수위1.52 ±0.59d,대조조술후평균발열천수위1.00±1.01d,채용단인소방차분석,P ＞0.05,무명현차이;실험조술후백세포위9.05±2.95(×109/L),대조조술후백세포위8.68±2.81(×109/L),채용단인소방차분석,P＞0.05,무명현차이;실험조술후중성비위83.65±9.83％,대조조술후중성비위86.04 ±7.87％,채용단인소방차분석,P＞0.05,이자무명현차이;실험조술후평균주원시간8.84±0.37d,대조조술후평균주원시간8.14±1.82d,채용단인소방차분석,P＞0.05,이자무명현차이.결론 대우술중천자학진위농신적환자,채용희석락합전충세후일기행경피신경쇄석취석술경료효분석시안전적、가고적,술후병발증소,회복쾌,림상증실유효.
Objectives To explore a economical,simple and effective measure that can ensure the safety of upper tract calculus complicated with pyonephrosis patients with the first stage mini-percutaneous nephrostolithotomy,and also reduce the number of operations,lighten the burden of patients.Methods This was a prospective trial of group control study,the trial of the patients who undergoing first stage mPCNL between December 2011 and April 2013 in xiangya hospital of central-south university.and the patients must correspond with group measure.The patients are divided into the experimental group and the control group.The experimental group was patients with pyonephrosis flushed with dilute complexing iodine;The control group was the common patients.Compare two groups of patients with postoperative fever(routine blood 、degree of fever、days of fever) 、culture results of puncture fluid after washing 、hospital stays of postoperation.The first two results were mainly compared.The data was analyzed by SPSS19.0.Results Fifty-one patients in this topic were performed mPCNL successfully,twety-two patients were diagnosed pyonephrosis during operation and then accepted the first stage mini-percutaneous nephrolithotomy after flushed with dilute complexing iodine,There were twenty-nine patients in the control group.In experimental group,the cultivate results of punctured fluid before and after flushed were statistical significance (by chi-square test,P ＜ 0.05),the averaged postoperative fever days of experimental group were 1.52 ± 0.59 days,The control group were 1.00 ± 1.01 days,there was no statistical significance(by one-factor analysis of variance,P ＞ 0.05),the postoperative leukocyte of experimental group were 9.05 ± 2.95 (× 109 / L) and the control group were 8.68 ± 2.81 (× 109 / L),there were no statistical significance(by one-factor analysis of variance,P ＞ 0.05),the postoperative neutrophils ratio of experimental group were 83.65 ± 9.83％ and the control group were 86.04 ± 7.87％,there were no statistical significance(by one-factor analysis of variance,P ＞0.05),The average length of hospital stay after surgery in experimental group were 8.84 ±0.37 days and the control group were 8.14 ± 1.82 days,also there were no statistical significance (by one-factor analysis of variance,P ＞ 0.05).Conclusions Patients with intraoperative biopsy diagnosed with pyonephrosis were safe and reliable that accepted the first stage mPCNL after flushed with dilute complexing iodine,The postoperative complications rarely appeared,Patients recovered quickly.