| Objective: We did this study to explore the clinical application of color Doppler ultrasound in accurately establishing the percutaneous nephrolithotomy channel.the advantages of color Doppler ultrasound in the establishment of percutaneous renal surgery was analyzed by comparing the clinical efficacy of color Doppler ultrasound guided and ordinary B-mode ultrasound in guideing percutaneous nephroscope surgery.Then we analyze the factors that may affect the accuracy of puncture during color Doppler ultrasound-guided percutaneous nephroscope surgery.The paper studied how to improve the success rate of accurate puncture to the target renal calyces,improve surgical efficiency and reduce surgical complications.Renal artery,renal interlobular artery peak systolic flow velocity(PSV),diastolic minimum flow velocity(EDV)and resistance index(RI)were detected to explore the influence of PCNL on renal hemodynamics.It is of great clinical significance for surgeons to better apply color doppler ultrasound technology in this operation,and make good use of the sword of color doppler ultrasound in the face of different patients to develop a relatively personalized treatment plan.Methods: Retrospective analysis was performed on 107 patients who met the inclusion criteria and underwent minimally invasive percutaneous nephrolithotomy in the urology department of Chenzhou NO.1People’s Hospital from January 2017 to June 2020.(1)According to the different guidance methods for the establishment of percutaneous nephrolithotomy channels,the cases were divided into: ordinary ultrasound guidance group and color doppler ultrasound guidance group,among which 54 cases were in the ordinary ultrasound group and 53 cases in the color doppler ultrasound group;Collected respectively in patients with general information,as well as side classification,whether antler shape stones,the existence of bacteriuria,the degree of suffering from kidney seeper,cross sectional diameter,biggest stones of CT value,from skin to the diameter of the calyces distance of target,the target calyces and renal parenchyma thickness,postoperative hospitalization days,stone clearance rate and perioperative complications related situation,carries on the statistical analysis between groups,color doppler ultrasound and ordinary ultrasound guided by the two ways in the entire operation of the process and the occurrence of postoperative complications of whether there is a certain difference in colour to exceed whether is superior to the ordinary ultrasound group.(2)There are many factors that affect the success rate of puncture under the guidance of color Doppler ultrasound.Therefore,we carry out statistical analysis on various factors that may have an impact.According to normal work experience,the angle of needle insertion during puncture is of vital importance to the success of puncture.By consulting the literature,it is found that there are few studies on the influence of the needle insertion angle on the success rate of puncture.Therefore,this study is divided into the vertical renal surface needle insertion group and the non-perpendicular renal surface needle insertion group according to whether the puncture needle under the guidance of color Doppler ultrasound is perpendicular to the kidney surface,30 cases in the vertical injection group,23 cases in the non-vertical injection group,the success rate of one-time puncture was calculated,and the X2 test was used in the comparison study between groups.(3)Under the guidance of color Doppler ultrasound,puncture the target renal calyx.After expanding the channel,the nephroscope/ureteroscope enters the channel to observe the situation in the channel.According to the literature standard,accurate puncture means that the vision in the channel is clear when the channel is observed.The inner wall of the channel is smooth and mucosal protrusions are visible;non-precision puncture means that the visual field is not clear enough after entering the nephroscope,and the torn mucosa and fibrofatty tissue can be seen;the general information of the patient and the side of the stone,whether it is staghorn stone,Whether there is bacteriuria,degree of hydronephrosis,maximum cross-sectional diameter of the stone,CT value of the stone,distance from the skin to the target renal calyx,diameter of the target renal calyx,and renal parenchymal thickness,etc.,perform a single factor analysis of the above factors,and The statistically significant variables in univariate analysis were analyzed by binary Logistis regression analysis to obtain independent factors with significant influencing significance,that is,to analyze the influencing factors that are conducive to the accurate percutaneous renal puncture target under the guidance of color Doppler ultrasound;(4))Use color Doppler ultrasound to measure the peak systolic velocity(PSV)and minimum diastolic velocity(EDV)of the renal aorta,renal arteries,and interlobular arteries in PCNL patients before operation,1 week after operation,1 month after operation,and 3 months after operation And resistance index(RI)to explore the influence of PCNL on renal hemodynamics.Results:(1)There were 53 cases in the color Doppler ultrasound guided group and 54 cases in the B-ultrasound guided group.Statistical analysis found that the percutaneous renal channel established by color Doppler ultrasound and B-ultrasound guided by age,gender,BMI,side of the stone,staghorn stone,whether There was no statistical difference in bacteriuria,hydronephrosis degree,maximum diameter of stone cross-section,stone CT value,postoperative hospital stay,stone clearance rate(P>0.05),that is,the baseline data and severity of the two groups of cases are balanced and comparable Sex.Statistical analysis showed that the serious complications during the perioperative period in the color Doppler ultrasound group were significantly less than those in the B ultrasound group(P<0.05).There is a statistical difference;(2)Under the guidance of color Doppler ultrasound,percutaneous renal puncture,27 cases in the vertical needle group,26 cases in one puncture Success,1case succeeded in the second puncture;in the non-vertical needle group 26 cases,17 cases succeeded in the first puncture,6 cases succeeded in the second or more punctures.A comparative study between groups was conducted,P<0.05,which was statistically significant.(3)In the single factor analysis,BMI,the distance from the skin to the target renal calyx,and the diameter of the target renal calyx may be the factors affecting the accuracy of color Doppler ultrasound puncture.In the multi-factor analysis,the distance from the skin to the target renal calyx and the diameter of the target renal calyx may be Independent factors affecting the accuracy of puncture.(4)The peak systolic flow rate(PSV),minimum diastolic flow rate(EDV)and resistance index(RI)of the renal aorta,renal segment arteries,and interlobular arteries were similar to the preoperative level(P>0.05).The peak systolic velocity(PSV)and minimum diastolic velocity(EDV)of the renal aorta,segmental arteries and inter-renal arteries increased significantly in January and March after surgery,and the resistance index(RI)was significantly lower than the preoperative level(P<0.05)Conclusion:(1)Compared with ordinary B-ultrasound guidance,there are fewer serious complications in percutaneous renal channel establishment.(2)Factors affecting the accuracy of percutaneous renal channel establishment under the guidance of color Doppler ultrasound are: the distance from the skin to the target renal calyx,the diameter of the target renal calyx,and whether the needle is inserted perpendicular to the surface of the kidney.(3)After PCNL,various renal hemodynamic parameters can be effectively improved. |
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