本文選題：體外沖擊波碎石　切入點：泌尿系結(jié)石　出處：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討影響體外沖擊波碎石(ESWL)治療尿路結(jié)石效果的相關因素,為臨床實踐提供參考。方法:選取我院自2011年1月至2016年10月應用白云山BYS液電式B超定位體外沖擊波碎石機及西門子MODULARIS Variostar電磁式雙定位體外沖擊波碎石機行體外沖擊波碎石(ESWL)治療的4101例尿路結(jié)石的患者,其中男性2740例,女性1361例,年齡9~84歲,平均43.05±13.13歲,其中腎結(jié)石745例,輸尿管結(jié)石3180例,膀胱結(jié)石176例。體外沖擊波碎石的絕對禁忌癥有:結(jié)石遠端伴有炎性息肉等造成的梗阻,血液性疾病導致出血性疾病、伴有腦梗塞、腦出血等腦部疾病,婦女有妊娠的同時患者泌尿系結(jié)石,體重過于肥胖,患者先天性的骨骼畸形導致肢體畸形發(fā)育,伴有嚴重心臟疾病安置心臟起搏器等。本組研究將輸尿管狹窄、無功能腎等特殊情況納入體外沖擊波碎石禁忌。本組所有患者均經(jīng)泌尿系統(tǒng)超聲、腹部X線平片或靜脈腎盂造影,以及泌尿系CT平掃等檢查。每個患者均進行手術前疾病信息資料搜集整理,術中影像學圖像保存與記錄,術后隨訪資料包括完整的影像學檢查資料以及臨床癥狀等隨訪內(nèi)容。所有患者均在術后1周開始隨訪,隨訪時間3個月。結(jié)石完全排出或殘石≤3mm并伴有腎積水緩解視為治療成功,結(jié)石未排出或殘石3mm且腎積水無減輕或加重視為治療失敗。應用統(tǒng)計學方法分析影響體外沖擊波碎石治療泌尿系結(jié)石效果的因素。結(jié)果:所有行ESWL治療的患者術后隨訪3個月,治療成功3403例,凈石率(成功率)為82.98%;體外沖擊波碎石失敗包括結(jié)石質(zhì)地堅硬,未能擊碎并排出體外,或者伴有較多的碎塊化結(jié)石殘余698例,碎石的失敗率為17.02%。在698例碎石失敗的的患者中,因結(jié)石質(zhì)地堅硬所致結(jié)石不能被粉末化或碎塊化者有595例,所占比例為85.24%。結(jié)石碎塊化后的各個部分較大,導致結(jié)石不能排出體外者占14.76%。接受ESWL的所有患者中6例患者術后出現(xiàn)腎包膜下血腫,經(jīng)保守治療后半年復查CT,血腫消失。以治療效果為依據(jù),將患者分為2組,結(jié)石完全排出或殘石≤3mm為手術成功組,結(jié)石質(zhì)地堅硬導致碎石失敗或者碎塊化的結(jié)石各部分較大,未能順利排出體外,通常各部分結(jié)石直徑3mm為治療失敗組。應用χ~2檢驗以及t檢驗來比較兩組患者的資料。結(jié)論:分析表明,碎石機的種類、患者的年齡、體重指數(shù)(BMI)、結(jié)石的位置、皮膚距離結(jié)石距離(SSD)、定位方式及沖擊波源的入路、沖擊波的頻率及碎石過程中能量遞增方式是影響ESWL治療效果的重要因素。泌尿系結(jié)石患者在接受體外沖擊波碎石前需要選擇合適的體外碎石機,對泌尿系結(jié)石患者的綜合情況進行分析,爭取采取個體化的治療方案,取得最佳碎石效率。
[Abstract]:Objective: to explore the factors influencing the effect of ESWL on urinary calculi and to provide reference for clinical practice.Methods: from January 2011 to October 2016, patients with extracorporeal shock wave lithotriptor (ESWL) were treated with Baiyunshan BYS ultrasonic lithotriptor and Siemens MODULARIS Variostar electromagnetic double location extracorporeal shock wave lithotriptor.4101 patients with urinary calculi,Among them, 2740 cases were male, 1361 cases were female, the age was 984 years old (mean 43.05 鹵13.13 years), including 745 cases of renal calculi, 3180 cases of ureteral calculi and 176 cases of bladder stones.The absolute contraindications of extracorporeal shock wave lithotripsy include obstruction caused by distal stone with inflammatory polyps, hemorrhagic diseases caused by blood diseases, cerebral infarction, cerebral hemorrhage and other brain diseases.Overweight, congenital skeletal deformities lead to limb deformity and severe heart disease with pacemakers.In this study, ureteral stricture, non-functional kidney and other special conditions were included in extracorporeal shock wave lithotripsy taboo.All patients were examined by urography, plain film or intravenous pyelography, and CT scan of urinary system.Each patient underwent pre-operation information collection, intraoperative imaging image preservation and recording, and follow-up data including complete imaging data and clinical symptoms.All patients were followed up 1 week after operation for 3 months.Complete excretion of stone or residual stone 鈮，

本文編號：1725603