输尿管镜辅助下两步扩张法建立经皮肾通道在日间手术的应用(单中心110例报告)

Establishment of percutaneous renal passage in day surgery by ureteroscopeassisted two-step expansion method——Annual clinical report of 110individuals in a single center

目的:探讨微通道经皮肾镜取石术(mPCNL)中初步应用输尿管镜辅助下两步扩张法建立经皮肾镜通道的效果。方法:回顾性分析2020年2月-2020年12月110例接受日间mPCNL治疗的患者的临床资料。结果:110例患者均一次性完成通道建立并一期成功碎石,通道建立平均时间(3.2±0.4)min,手术操作平均时间(35.3±15.3)min。30例实行完全无管化,69例为部分无管化。术后1天患者的结石清除率为94.5%,术后第4周结石清除率为97.3%。术后发生明显肉眼血尿并接受输血治疗者1例,无高热、肾周脏器损伤、脓毒血症、休克等严重并发症的发生。结论:输尿管镜辅助下两步扩张法步骤清晰,简便易学,能直视观察通道内具体情况并及时调整改错,明显提高了一次性通道建立成功率,降低了围术期并发症发生率,为日间PCNL成功的实施提供了坚实保障。

Objective:To explore the establishment of percutaneous nephroscope channel in daytime mini-percutaneous nephrolithotoy(mPCNL)surgery by ureteroscope-assisted two-step dilation method.Methods:A retrospective analysis of 110 patients who underwent day mPCNL in our hospital from February 2020 to December 2020 was done.Results:All channel establishment and lithotripsy job were successfully completed at one time.The channel establishment time averaged(3.2±0.4)min,and the operation time averaged(35.3±15.3)min.Thirty cases were completely deregulated and 69 cases were partially deregulated.The stone clearance rate was 94.5%on the first day after surgery and 97.3%on the fourth week after surgery.Obvious gross hematuria and blood transfusion occurred in1 case after the operation.No serious complications such as high fever,perirenal organ damage,sepsis,shock occurred.Conclusion:The two-step expansion method with theaid of ureteroscope has clear steps,is simple and easy to learn,can directly observe the specific conditions in the channel and adjust and correct errors in time,which significantly improves the success rate of one-time channel establishment and reduces surgical complications,andprovides a solid guarantee fordaily surgery in PCNL.