彩色多普勒血流联合超声实时监控在经皮肾镜取石术中的临床应用

Clinical Application of Color Doppler Flow Combined with Real-time Ultrasound Monitoring in Percutaneous Nephrolithotomy

探讨彩色多普勒血流显像联合超声实时监控在经皮肾镜取石术(PCNL)中的临床应用价值。回顾性分析2021年1月-2022年5月,采用PCNL治疗肾/输尿管结石的256例患者临床资料,男126例,女130例,在穿刺时根据是否开启及采用彩色多普勒血流显像分为超声灰阶扫描穿刺组(观察组)及彩色多普勒血流显像联合超声灰阶扫描穿刺组(对照组),比较两组在术中的通道建立情况、手术时间、术中出血及冲洗液用量情况,术后观察清石率、并发症情况等指标,评估手术效果。两组256例患者均I期完成手术,观察组与对照组在术中初次通道建立成功率(99.2%vs 98.5%)、通道建立时间[(3.4±0.6)min vs(3.3±0.7)min]、手术时间[(96.2±18.4)min vs(100.3±16.7)min]、多通道(18.3%vs 21.5%),差异无统计学意义(P>0.05);需要夹闭肾造瘘止血比率(3.2%vs 0)、术中冲洗液用量[(13.8±4.1)L vs(12.3±2.6)L],差异有统计学意义(P<0.05)。观察组与对照组并发症情况比较,出血比率(5.6%vs 0.8%)、肾周血肿(3.2%vs 0)、输血率(4.0%vs 0)、介入栓塞比率(3.2%vs 0)、血红蛋白下降[(20.9±10.9)g/L vs(16.7±6.9)g/L],差异有统计学意义(P<0.05);发热率(10.3%vs 9.2%)、气胸及胸腔积液发生率(0.8%vs 1.5%)、残石率(7.9%vs 9.2%),差异无统计学意义(P>0.05)。彩色多普勒血流显像联合超声实时监控在PCNL能够有效地避免损伤肾脏较大的动脉分支血管,降低PCNL出血并发症的比例,提高穿刺成功率,降低残石率,避免脏器损伤等并发症的发生。

To evaluate the clinical value of color Doppler flow imaging(CDFI)combined with real-time ultrasound monitoring in percutaneous nephrolithotomy(PCNL),the clinical data of 256 patients with renal/ureteral calculi treated with PCNL from January 2021 to May 2022 were analyzed retrospectively.According to whether the puncture was turned on or not and color Doppler flow imaging was used,the patients were divided into two groups:ultrasound gray scale puncture group(observation group)and color Doppler flow imaging combined with ultrasound gray scale puncture group(control group).The establishment of intraoperative passage,operation time,intraoperative bleeding and flushing fluid dosage were compared between the two groups,and the stone removal rate and complications were observed after operation to evaluate the surgical effect.All the patients in the two groups completed the operation in I stage.There was no significant difference in the success rate of initial channel establishment(99.2%vs),channel establishment time(3.4±0.6)min vs(3.3±0.7)min,operation time(96.2±18.4)min vs(100.3±16.7)min,multi-channel(18.3%vs 21.5).The hemostatic rate of clamping nephrostomy(3.2%vs 0)and the amount of intraoperative irrigation solution[(13.8±4.1)L vs(12.3±2.6)L]were significantly different(P<0.05).There were significant differences in bleeding rate(5.6%vs 0.8%),perirenal hematoma(3.2%vs 0),blood transfusion rate(4.0%vs 0),interventional embolization rate(3.2%vs 0),hemoglobin decrease[(20.9±10.9)g/L vs(16.7±6.9)g/L]between the two groups.There was no significant difference in fever rate(10.3%vs 9.2%),pneumothorax and pleural effusion rate(0.8%vs 1.5%),and residual stone rate(7.9%vs 9.2%).Color Doppler flow imaging combined with real-time ultrasound monitoring in PCNL can effectively avoid damage to large branches of renal arteries,reduce the proportion of complications of PCNL bleeding,improve the success rate of puncture,reduce the rate of residual stones,and avoid complications such as organ injury.