【摘要】 目的探讨侧卧位输尿管镜碎石术治疗上尿路结石相关技术因素的理论与临床研究。方法选取2016年9月～2019年6月我院30例患者术后拍片。观察D点(骶髂关节前方与双J管的交点)以上的夹角与D点以下的夹角的大小;患者侧卧平直位、屈髋90°与尽量弓腰弓背输尿管远段弯曲度角角度变化的大小;侧卧位屈髋90°与尽量弓腰弓背双J管近端整圆起点与相应椎体矢状面中线的距离大小;平卧位与腰椎尽量凸向患侧位的双J管近端整圆起点与相应椎体冠状面中线的距离的大小。结果输尿管远段起点弯曲度上角与输尿管远段起点弯曲度下角的大小差异有统计学意义(P <0.05),输尿管远段起点弯曲度下角大于输尿管远段起点弯曲度上角;患者侧卧平直位、屈髋90°与尽量弓腰弓背输尿管远段弯曲度角角度变化的比较,差异均有统计学意义(P <0.001),平直位的夹角大于屈髋90°输尿管远段弯曲度夹角,屈髋90°输尿管口的夹角大于尽量弓腰弓背输尿管远段弯曲度夹角;侧卧位屈髋90°与尽量弓腰弓背双J管近端整圆起点与相应椎体矢状面中线的距离(矢状面)水平比较,差异有统计学意义(P <0.05),尽量弓腰弓背双J管上段与椎体中线的距离(矢)大于侧卧位屈髋90°双J管上段与椎体中线的距离(矢);平卧位与腰椎尽量凸向患侧位的双J管近端整圆起点与相应椎体冠状面中线的距离(冠状面)水平比较,差异无统计学意义(P> 0.05)。结论矢状面腰骶关节点下方的弯曲度对进镜操作影响大,采取合适屈髋体位,使输尿管下段曲度趋向平直,有助于操作时输尿管进镜;弓腰弓背影响矢状面输尿管上段的平移程度、弓腰弓背或伸展患侧有助于克服矢状面输尿管迂曲。但在冠状面下腰椎尽量凸向患侧位使输尿管上段趋向平直,差异无统计学意义。更多还原

【Abstract】 Objective To investigate the theoretical and clinical study on the technical factors associated with ureteroscopic lithotripsy in lateral position in the treatment of upper urinary tract calculi. Methods 30 patients at our hospital from September 2016 to June 2019 were selected for postoperative radiography.The size of the angle above the point D(the intersection of the sacroiliac joint and the double-J stent)and the angle below the point D;the magnitude of angular variation of curvature angle at the distal segment of ureter in the lateral and flat position,at 90° flexion of hip and during dorsiflexion as much as possible;the distance between the full circle starting point at the proximal end of double-J stent at 90° flexion of hip in lateral position and during dorsiflexion as much as possible and the midline of the sagittal plane of the corresponding vertebral body;and the distance between the full circle starting point at the proximal end of double-J stent in horizontal position and in the situation where the lumbar vertebra was protruding as far as possible to the affected side and the midline of the coronal plane of the corresponding vertebral body were observed. Results The difference between the upper angle of curvature of the distal starting point of ureter and the lower angle of curvature of the distal starting point of ureter was statistically significant(P < 0.05);the lower angle of curvature of the distal starting point of ureter was greater than the upper angle of curvature of the distal starting point of ureter;the difference in the angular variation of curvature angle at the distal segment of ureter at 90 ° flexion of hip in the lateral and flat position and during dorsiflexion as much as possible was statistically significant(P < 0.001);the angle in the flat position was greater than that of curvature at the distal segment of ureter at 90 ° flexion of hip,and the angle of the ureteral orifice at 90 ° flexion of hip was greater than that of curvature at the distal segment of ureter during dorsiflexion as much as possible;the difference in the distance between the full circle starting point at the proximal end of double-J stent at 90 ° flexion of hip in lateral position and during dorsiflexion as much as possible and the midline of the sagittal plane of the corresponding vertebral body(sagittal plane)was statistically significant(P < 0.05);the distance between the upper segment of double-J stent during dorsiflexion as much as possible and the midline of the vertebral body(sagittal)was greater than that between the upper segment of double-J stent at 90° flexion of hip in lateral position and the midline of the vertebral body(sagittal);the difference in the distance between the full circle starting point at the proximal end of double-J stent in horizontal position and in the situation where the lumbar vertebra was protruding as far as possible to the affected side and the midline of the coronal plane of the corresponding vertebral body(coronal plane)was not statistically significant(P >0.05). Conclusion The curvature below the lumbosacral joint in sagittal plane has great influence on the operation of ureteroscopy.Adopt an appropriate hip flexion position to make the lower curvature of ureter tend to be straight,which is helpful for ureteroscopy during operation;dorsiflexion affects the degree of translation of the upper segment of sagittal ureter,and dorsiflexion or extension of the affected side helps to overcome sagittal ureteral tortuosity.However,under the coronal plane,the lumbar vertebra protruding as far as possible to the affected side makes the upper segment of ureter tend to be straight,and the difference is not statistically significant.更多还原