免人工肾积水在超声引导经皮肾镜取石术中的应用

Efficacy and safety of ultrasound-guided percutaneous nephrolithotomy without artificial hydronephrosis in patients with different degrees of hydronephrosis

目的探讨超声引导经皮肾镜取石术中不制造人工肾积水的安全性及有效性。方法回顾性分析2019年1月至2021年12月济宁医学院附属医院泌尿外科收治的395例行经皮肾镜取石术的患者的临床资料。将395例患者根据术前CT中肾积水的程度分3层(无肾积水层、轻度肾积水层、中重度肾积水层)进行比较,每层按照手术方法分为人工肾积水组与免人工肾积水组,比较2组患者的一针穿刺成功率、手术时间、术中出血、一期结石清除率、术后发热发生率、术后住院时间的差异。结果2组患者一般资料差异无统计学意义(P>0.05)。无肾积水层,人工肾积水组与免人工肾积水组的手术时间分别为[(54.8,95.5)min vs(25.0,56.0)min,P<0.01]、术中出血[(10,25)ml vs(5,20)ml,P<0.01]、术后住院时间分别为[(3.0,5.0)d vs(2.0,4.0)d,P<0.01],差异均有统计学意义(P<0.05)。轻度肾积水层,人工肾积水组与免人工肾积水组的手术时间分别为[(65.0,115.8)min vs(25.0,40.0)min,P<0.01]、术中出血[(20,50)ml vs(5,20)ml,P<0.01]、术后住院时间分别为[(3.0,6.0)d vs(2.0,4.0)d,P<0.01],差异均有统计学意义(P<0.05)。中重度肾积水层,人工肾积水组与免人工肾积水组的手术时间分别为[(60.0,111.0)min vs(25.0,60.0)min,P<0.01]、术中出血[(10,30)ml vs(5,20)ml,P<0.01]、术后住院时间分别为[(3.0,5.0)d vs(2.0,4.0)d,P<0.01]。2组患者的一针穿刺成功率、一期结石清除率、术后发热发生率差异无统计学意义(P>0.05)。结论超声引导经皮肾镜取石术术中不建立人工肾积水是一种治疗不同积水程度的肾结石安全有效的手术方式,具有手术时间短、术后恢复快等优势。

Objective To evaluate the safety and effectiveness of ultrasound-guided percutaneous nephrolithotomy without artificial hydronephrosis.Methods The clinical data of 395 patients who underwent percutaneous nephrolithotomy at the Department of Urology Affiliated Hospital of Jining Medical University from January 2019 to December 2021 were retrospectively analyzed.The patients were divided into three groups(no hydronephrosis,mild hydronephrosis,and moderate/severe hydronephrosis)according to the degree of preoperative CT hydronephrosis assessed by preoperative CT,and each group was further divided into either an artificial hydronephrosis group or a no artificial hydronephrosis group according to the surgical method used.The differences in the one-time puncture success rate,operation time,intraoperative bleeding,one-stage calculus clearance rate,the incidence of postoperative fever,and postoperative hospital stay were compared between the artificial hydronephrosis group and the no artificial hydronephrosis group.Results There was no significant difference in general data between the two groups(P>0.05).For patients without hydronephrosis,operative time[(54.8,95.5)min vs(5.0,60.0)min,P<0.01],intraoperative blood loss[(10,25)ml vs(5,20)ml,P<0.01],and postoperative hospital stay[(3.0,5.0)d vs(2.0,4.0)d,P<0.01]differed significant between the artificial hydronephrosis group and the no artificial hydronephrosis group.For patients with mild hydronephrosis,operative time[(65.0,115.8)min vs(25.0,40.0)min,P<0.01],intraoperative blood loss[(20,50)ml vs(5,20)ml,P<0.01],and postoperative hospital stay[(3.0,6.0)d vs(2.0,4.0)d,P<0.01]also differed significantly between the artificial hydronephrosis group and the no artificial hydronephrosis group.For patients with moderate/severe hydronephrosis,operative time[(60.0,111.0)min vs(25.0,60.0)min,P<0.01],intraoperative blood loss[(10,30)ml vs(5,20)ml,P<0.01],and postoperative hospital stay[(3.0,5.0)d vs(2.0,4.0)d,P<0.01]still differed significantly between the artificial hydronephrosis group and the no artificial hydronephrosis group.There was no significant difference in the one-needle puncture success rate,one-stage calculus clearance rate,and the incidence of postoperative fever between the two groups(P>0.05).Conclusion Ultrasound-guided percutaneous nephrolithotomy without artificial hydronephrosis is safe and effective for the treatment of kidney stones with different degrees of hydronephrosis,which can shorten operation time and accelerate postoperative recovery.