摘要
目的观察80例非肾脏疾病患者侧卧位与俯卧位超声检查肾脏活动度及11肋间隙变化,探讨选择侧卧位超声引导实施经皮肾镜碎石取石术(PCNL)的解剖理论依据。方法 80例非肾脏疾病患者先后行垫腹俯卧位(被检查者俯卧后在上腹部加垫枕,垫枕宽50cm、高10cm)和垫腰侧卧位(被检查者侧卧后在腰部加垫枕,垫枕规格同上)肾脏超声检查,利用点追踪技术、使用超声系统附带的测量软件测量侧卧位和俯卧位时肾脏移动度、俯卧位转为侧卧位时肾脏下移距离、肾脏后组中盏至体表距离、11肋间隙。结果 侧卧位时左肾上下移动度为(13.7±3.0)mm、左右移动度为(1.5±0.4)mm、前后移动度为(1.7±0.4)mm,俯卧位时左肾上下移动度为(8.6±2.0)mm、左右移动度为(1.2±0.2)mm、前后移动度为(1.2±0.3)mm,两者相比,P均<0.05。侧卧位时右肾上下移动度为(13.9±3.7)mm、左右移动度为(1.5±0.4)mm、前后移动度为(1.7±0.3)mm,俯卧位时右肾上下移动度为(8.6±2.5)mm、左右移动度为(1.2±0.2)mm、前后移动度为(1.2±0.2)mm,两者相比,P均<0.05。俯卧位转为侧卧位时,左肾下移的距离为(19.8±3.3)mm,右肾下移的距离为(17.7±4.2)mm,两者相比,P<0.05。侧卧位时左肾后组中盏至体表距离为(60.1±13.7)mm、右肾后组中盏至体表距离为(59.7±12.9)mm,俯卧位时左肾后组中盏至体表距离为(54.0±11.3)mm、右肾后组中盏至体表距离为(55.3±11.5)mm,两者相比,P均<0.05。侧卧位时11肋间隙左侧为(23.9±1.1)mm、右侧为(24.4±1.6)mm,俯卧位时11肋间隙左侧为(22.4±0.6)mm、右侧为(22.2±0.9)mm,两者相比,P均<0.05。结论 相比于俯卧位,侧卧位时肾脏移动度增大、肾脏位置下移、11肋间隙增大、肾脏后组中盏至体表距离增加;侧卧位行超声引导下PCNL可以提高手术安全性,降低手术难度。
Objective To observe the changes of renal activity and 11 intercostal space in 80 patients with non-renal diseases in lateral position and prone position by ultrasonography, and to explore the anatomical theoretical basis for the selection of ultrasound guided percutaneous lithotripsy (PCNL) in lateral position. Methods Eighty patients with non-renal diseases underwent ultrasonic examination of the kidney in the prone position (the examinee lies prone, a pillow with a width of 50 cm and a height of 10 cm is added to the upper abdomen) and the lateral position (the examinee lies on the side and we adds a pillow at the waist, the pillow specification is the same as the above). Point tracking technology and measurement software attached to the ultrasonic system were used to measure the degree of kidney movement in the lateral and prone positions, the distance of the kidney moving downward when the prone position was changed to the lateral position, the distance from the calyx to the body surface in the posterior group, and the 11 intercostal space. Results In the lateral position, the up and down mobility of the left kidney was (13.7±3.0) mm, the left and right mobility was ( 1.5 ±0.4) mm, and the front and rear mobility was (1.7±0.4) mm, while in the prone position, the up and down mobility of the left kidney was (8.6±2.0) mm, left and right mobility was (1.2±0.2) mm, and the front and rear mobility was ( 1.2 ±0.3) mm, with statistically significant difference, all P <0.05. In the lateral position, the up and down mobility of the right kidney was (13.9±3.7) mm, the left and right mobility was (1.5±0.4) mm, and the front and rear mobility was (1.7±0.3) mm;in the prone position, the up and down mobility of the right kidney was (8.6±2.5) mm, the left and right mobility was (1.2±0.2) mm, and the front and rear mobility was (1.2±0.2) mm, with statistically significant difference, all P <0.05. When the prone position was changed to the lateral position, the distance of the left kidney descending was (19.8±3.3) mm, and the distance of the right kidney descending was (17.7±4.2) mm, respectively, with statistically significant difference, P <0.05. The distance from the calyx to the body surface of the left posterior renal group was (60.1±13.7) mm, and that of the right posterior renal group was (59.7±12.9) mm in the lateral position. The distance from the calyx to the body surface of the left posterior renal group was (54.0±11.3) mm and that of the right posterior renal group was (55.3±11.5) mm in the right posterior renal group in the prone position, with statistically significant difference, all P <0.05. In the lateral position, the left side of the 11 intercostal space was (23.9±1.1) mm and the right side was (24.4±1.6) mm;in the prone position, the left side of the 11 intercostal space was ( 22.4 ± 0.6 ) mm and the right side was (22.2±0.9) mm, with statistically significant difference, all P <0.05. Conclusions Compared with the prone position, the lateral position shows increased renal mobility, decreased renal position, increased 11 intercostal space, and increased distance from the calyces to the body surface in the lateral position. Ultrasound-guided PCNL in the lateral position can improve the safety and reduce the difficulty of operation.
作者
陈熙
梁学志
王硕
杨世海
张彬
张旭辉
王东文
CHEN Xi;LIANG Xuezhi;WANG Shuo;YANG Shihai;ZHANG Bin;ZHANG Xuhui;WANG Dongwen(Shanxi Medical University, Taiyuan 030001, China)
出处
《山东医药》
CAS
2019年第24期40-43,共4页
Shandong Medical Journal
关键词
经皮肾镜碎石取石术体位
肾脏超声检查
肾脏超声检查体位
侧卧位
俯卧位
肾脏活动度
11肋间隙
position of percutaneous nephrolithotomy
renal ultrasonography
position of renal ultrasonography
lateral position
prone position
kidney activity
11 intercostal space
