改良经皮肾输尿管镜取石术治疗无积水肾结石

Modified percutaneous nephrostomy ureteroscopy lithotropsy for renal calculus without hydronephrosis

目的:探讨改良经皮肾输尿管镜取石术治疗无积水肾结石在提高同期取石成功率、减少并发症和降低手术人员放射线的接触时间方面的临床意义。方法:将无肾积水、肾实质厚度大于2cm、经皮肾穿刺建立通道有一定难度的103例随机分成两组:实验组50例、对照组53例。对照组采用传统方法,实验组采用改良方法建立通道。结果:实验组建立穿刺通道顺利,无输血病例,一期取石成功率100%。对照组穿刺建立通道过程中,损伤集合系统3例,发生严重出血2例,导致一期取石失败共计5例,一期取石成功率90.6%,需输血2例(3.8%)。两组一期取石成功率比较、手术人员累计暴露X线下时间差异有统计学意义。结论:针对无积水肾结石改良的穿刺建立通道方法安全、精确、一期取石成功率高,手术人员接触放射线时间短。

Objective： To study modified percutaneous nephrostomy ureteroscopy lithotropsy for treatment of renal calculus without hydronephrosis and evaluate the safety and efficacy of the new procedure. Methods： Percutaneous small tract puncture nephrostomy followed by ureteroscopic lithotripsy through the channel of the F16 trocar＇s sheath in the corresponding period was carried out in 103 cases of renal calculus without hydronephrosis. All cases were randomly divided into two groupsgroup A（ 50 cases） and group B （53 cases）. The groups A were operated by modified technique, and the other by traditional one. The difference between two groups for success and times of X-ray exposure were analysed in statistics. Results：The difference of success rate and time of exposing under X-ray were significant between group A and B （success rate P =0. 032, P〈0.05. the time of X ray exposure t= 2.69, P （0.01）. The success rate of group A and B was 100 % and 90.6 % , respectively. Two cases （3.8 % ） were performed blood transfusion in group B, however, the time of X-ray exposure in each group was 60 ±15 s and 15±5 s, respectively. Conclusions：The merits of the new puncture procedure are safe , effective and benefit to one-stage PCNL and short times of X ray exposure , particularly in treating renal stones without hydronephrosis.