泌尿生殖道瘘患者行超声联合X线引导下经皮肾造瘘术效果观察

Efficacy of ultrasound plus X-ray guided percutaneous nephrostomy on urogenital fistula

目的探讨泌尿生殖道瘘患者行超声联合X线引导下经皮肾造瘘术的效果及安全性。方法2018年1月-2023年9月河南省肿瘤医院诊治泌尿生殖道瘘患者70例,均行经皮肾造瘘术,采用超声联合X线引导者35例为观察组,采用模拟CT联合X线引导者35例为对照组,记录2组患者手术成功率、术中出血量、辐射暴露剂量、X线曝光时间、手术时间、住院时间,比较2组术前及术后7 d血肌酐、尿素氮水平,术后第1、3天采用术后恢复质量量表(QoR-15)评价术后恢复质量。结果观察组手术成功率(100.00%)高于对照组(88.57%)(χ^(2)=4.242,P=0.039),术中出血量[(3.06±1.12)mL]、辐射暴露剂量[(2.13±0.05)mGy]、X线曝光时间[(3.54±1.23)min]、手术时间[(30.21±8.38)min]、住院时间[(3.14±2.09)d]均少于对照组[(10.06±1.45)mL、(6.38±1.02)mGy、(9.52±2.73)min、(57.72±10.61)min、(4.52±2.42)d](t=22.550、24.630、11.830、12.041、2.540,P均<0.05)。观察组术后7 d血肌酐[(125.67±21.58)μmol/L]、尿素氮[(214.69±89.23)μmol/L]水平均低于对照组[(237.36±20.45)、(321.48±82.40)μmol/L](t=9.405,P<0.001;t=7.204,P=0.003),术前血肌酐[(389.24±19.83)μmol/L]、尿素氮[(459.34±106.38)μmol/L]水平与对照组[(375.24±18.63)、(468.30±98.45)μmol/L]比较差异均无统计学意义(t=1.562,P=0.862;t=1.295,P=0.390);2组术后7 d血肌酐、尿素氮水平均低于术前(t=6.766~53.205,P均<0.05)。观察组术后第1、3天QoR-15量表生理独立性、生理舒适度、心理支持、疼痛及情感评分均高于对照组(t=4.396~10.395,P均<0.05),2组术后第3天QoR-15量表生理独立性、生理舒适度、心理支持、疼痛及情感评分均高于术后第1天(t=-10.647~-5.801,P均<0.05)。结论泌尿生殖道瘘患者行超声联合X线引导下经皮肾造瘘术安全、有效,有微创、实时监测、手术成功率高、X线照射时间短、辐射暴露剂量小、术后恢复良好等优点。

Objective To investigate the efficacy and safety of ultrasound combined with X-ray guided percutaneous nephrostomy in patients with urogenital fistula.Methods Seventy patients with urogenital fistula were diagnosed and treated in Henan Cancer Hospital from January 2018 to September 2023.All patients underwent percutaneous nephrostomy,among whom 35 patients received surgery with the guidance of ultrasound plus X-ray(observation group)and the other 35 patients received surgery with the guidance of simulated CT plus X-ray(control group).The surgical success rate,intrasurgical blood loss,radiation exposure dose,X-ray exposure time,surgical time and length of hospital stay were recorded.The levels of serum creatinine and urea nitrogen were compared between two groups before and on day 7 after surgery.The postsurgical recovery was evaluated using the 15-item Quality of Recovery(QoR-15)scale on day 1 and 3 after surgery.Results The surgical success rate was higher in observation group(100.00%)than that in control group(88.57%)(χ^(2)=4.242,P=0.039).The patients in observation group had lower intrasurgical blood loss[(3.06±1.12)mL],lower radiation exposure dose[(2.13±0.05)mGy],shorter X-ray exposure time[(3.54±1.23)min],shorter surgical time[(30.21±8.38)min],and shorter hospital stay[(3.14±2.09)d]compared with those in control group[(10.06±1.45)mL,(6.38±1.02)mGy,(9,52±2.73)min,(57.72±10.61)min,(4.52±2.42)d](t=22.550,24.630,11.830,12.041,2.540;all P values<0.05).The levels of serum creatinine and urea nitrogen were lower in observation group[(125.67±21.58),(214.69±89.23)μmol/L]than those in control group[(237.36±20.45),(321.48±82.40)μmol/L]on day 7 after surgery(t=9.405,P<0.001;t=7.204,P=0.003),showed no significant differences between observation group[(389.24±19.83),(459.34±106.38)μmol/L]and control group[(375.24±18.63),(468.30±98.45)μmol/L]before surgery(t=1.562,P=0.862;t=1.295,P=0.390),and were lower in both group on day 7 after surgery than those before surgery(t=6.766-53.205,all P values<0.05).The scores of physical independence,physical comfort,psychological support,pain,and emotional state on the QoR-15 scale were higher in observation group than those in control group on day 1 and 3 after surgery(t=4.396-10.395,all P values<0.05),and were higher on day 3 after surgery than those on day 1 after surgery in both groups(t=-10.647to-5.801,all P values<0.(05).Conclusion Percutaneous nephrostomy under the guidance of ultrasound plus X-ray is safe and effective for patients with urogenital fistula,with the advantages as minimal invasiveness,real-time monitoring,high surgical success rate,short X-ray exposure time,low radiation exposure dose and quick recovery after surgery.