肾脏incool-3D立体影像技术在经皮肾镜碎石取石术中的应用及对结石清除率和术后恢复的影响

Application of renal incool-3D stereoscopic imaging technology in percutaneous nephrolithotomy for stone extractionand its efect on stone removal rate and postoperative recovery

目的研究肾脏incool-3D立体影像技术在微创经皮肾镜碎石取石术(mPCNL)中的应用及对结石清除率和术后恢复的影响。方法采取前瞻性研究,选择2020年1月至2021年9月在恩施土家族苗族自治州中心医院进行治疗的120例肾结石患者,其中男性59例,女性61例;年龄26~59岁,平均年龄为38.86岁;结石最大直径2.81~5.00 cm,平均直径4.42 cm;结石部位左侧56例,右侧64例;合并肾积水患者41例,合并泌尿系统感染患者52例。按照随机分组原则,分为观察组和对照组,每组60例。观察组患者采取肾脏incool-3D立体影像技术引导下的mPCNL治疗,对照组患者采取B超引导下mPCNL治疗。比较两组患者的治疗效果、麻醉药品使用情况、术后疼痛情况、术中穿刺点吻合度、穿刺目标肾盏吻合度、穿刺目标肾盏时间、手术时间、术后出血、术后感染、拔管引流时间、住院时间和术后并发症间的差异。结果两组患者结石清除率差异无统计学意义(96.67%vs 95.00%。χ^(2)=0.212,P=0.648)。观察组患者丙泊酚用量显著低于对照组(345.65 mg±112.03 mg vs 438.21 mg±111.33 mg。t=4.539,P=0.000),观察组患者术后麻黄碱(1.67%vs 13.33%。χ^(2)=5.891,P=0.015)、阿托品(3.33%vs 15.00%。χ^(2)=4.901,P=0.027)、艾司洛尔(5.00%vs 18.33%。χ^(2)=5.182,P=0.023)使用人数显著低于对照组,差异有统计学意义(P<0.05)。经过治疗后,观察组患者术后2 h(t=6.675,P=0.000)、6 h(t=5.852,P=0.000)、12 h(t=6.056,P=0.000)、24 h(t=7.586,P=0.000)静息状态的视觉模拟量表(VAS)评分均显著低于对照组。观察组患者穿刺点吻合度(χ^(2)=4.361,P=0.037)、穿刺目标肾盏吻合度(χ^(2)=4.182,P=0.041)显著高于对照组,穿刺目标肾盏时间(t=9.498,P=0.000)、手术时间(t=26.502,P=0.000)显著低于对照组,差异有统计学意义(P<0.05);观察组患者术后出血(χ^(2)=3.341,P=0.022)、术后感染(χ^(2)=4.821,P=0.028)、拔管引流时间(t=3.779,P=0.000)、住院时间(t=3.457,P=0.001)显著低于对照组;观察组患者的发热(χ^(2)=3.931,P=0.048)、血尿(χ^(2)=4.231,P=0.040)、恶心呕吐(χ^(2)=5.181,P=0.023)及肾绞痛(χ^(2)=8.091,P=0.005)情况显著低于对照组。结论在mPCNL中采用肾脏incool-3D立体影像技术进行穿刺点和穿刺路径规划,患者的术后恢复较好,建议临床推广。

Objective To study the application of renal incool-3D stereo imaging technology in mini percutaneous nephrolithotomy(mPCNL)and its effect on stone clearance and postoperative recovery.Methods From January 2020 to September 2021,a total of 120 patients with kidney stones were enrolled,which included 59 males and 61 females,aged 26-59 years old with mean age of 38.86 years old;maximum diameter of stones was 2.81-5.00 cm with mean diameter of 4.42 cm;56 cases in the left side and 64 in the right side;41 cases combined with hydronephrosis and 52 combined with urinary tract infection.According to randomized grouping principle,all of them were divided into observation group(n=60)and control group(n=60).The observation group performed mPCNL under guidance of renal incool-3D stereoscopic imaging technology,and control group was treated with mPCNL under guidance of B ultrasound.The treatment effect,anesthetic dosage,postoperative pain,anastomosis of intraoperative puncture site,anastomosis of puncture target calyx,puncture target calyces time,operation time,postoperative bleeding,postoperative infection,extubation drainage time,hospitalization time and postoperative complications were compared between 2 groups.Results There was no significant difference in stone clearance rate between 2 groups(96.67%s 95.00%.χ^(2)=0.212,P=0.648).The dosage of propofol in observation group was significantly lower than that in control group(345.65 mg±112.03 mg us 438.21 mg±111.33 mg.t=4.539,P=0.000),the use of postoperative ephedrine(1.67%vs 13.33%.χ^(2)=5.891,P=0.015),atropine(3.33%vs 15.00%.χ^(2)=4.901,P=0.027),and esmolol(5.00%vs 18.33%.χ^(2)=5.182,P=0.023)in observation group were statistically significantly lower than those in control group(P<0.05).After treatment,the scores of visual analogue scale(VAS)in the resting state at 2-hour(t=6.675,P=0.000),6-hour(t=5.852,P=0.000),12-hour(t=6.056,P=0.000)and 24-hour(t=7.586,P=0.000)were significantly lower in observation group than those in control group.The anastomosis of puncture site(xX?=4.361,P=0.037)and puncture target calyces(χ^(2)=4.182,P=0.041)in observation group were significantly higher than those in control group,while puncture target calyces time(t=9.498,P=0.000)and operation time(t=26.502,P=0.000)were significantly lower than those in control group(P<0.05).The postoperative bleeding(χ^(2)=3.341,P=0.022),postoperative infection(χ^(2)=4.821,P=0.028),extubation drainage time(t=3.779,P=0.000)and hospitalization time(t=3.457,P=0.001)in observation group were significantly lower than those in control group.The fever(χ^(2)=3.931,P=0.048),hematuria(χ^(2)=4.231,P=0.040),nausea and vomiting(χ^(2)=5.181,P=0.023),renal colic(χ^(2)=8.091,P=0.005)in observation group were significantly lower than those in control group.ConclusioInt is demonstrated that the use of renal incool-3D stereoscopic imaging for puncture site and puncture path planning in mPCNL improve postoperative recovery of patients and is recommended for clinical dissemination.