超声引导下肋间通路经皮肾镜取石术的疗效和安全性

Efficacy and Safety of Ultrasonography-Guided Percutaneous Nephrolithotomy via Supracostal Approach

目的探讨超声引导下肋间通路经皮肾镜取石术的疗效及安全性。方法2006年5月～2008年6月由一个手术小组完成110例超声引导下经皮肾镜取石术,62例采用肋间通路(第12肋上)经皮肾镜取石术(肋间通路组),48例采用肋下通路(肋缘下)经皮肾镜取石术(肋下通路组)。术前肋间通路组和肋下通路组分别有45例和36例行CT结石三维重建。结果肋间通路组结石取净率为72.6%(45/62),肋下通路组结石取净率为60.4%(29/48),2组结石取净率无统计学差异(χ2=1.818,P=0.178)。肋间通路组手术时间(78.6±5.1)min显著短于肋下通路组(102.4±7.1)min(t=-20.454,P=0.000)。肋间通路组及肋下通路组各有1例需要输血,肋间通路组有1例发生气胸,经保守治疗痊愈。结论肋间通路经皮肾镜取石术安全、有效。

Objective To evaluate the efficacy and safety of ultrasonography-guided percutaneous nephrolithotomy （PCNL）. Methods Between May 2006 and June 2008, 110 patients underwent PCNL by a single urological team at our hospital. The clinical data of the patients were retrospectively reviewed. Of the cases, supracostal access （ the 1 lth intercostal space） was made in 62 patients （supracostal group）, and subcostal access was obtained in 48 patients （ subcostal group）. Forty-five patients in the supracostal group （45/62） and 36 of the subcostal group （36/48） received CT three dimensional reconstruction. Results The stone free rate of the supracostal group was 72.6% （45/62） , while that of the subcostal group was 60.4% （29/48 ; Χ^2 = 1. 818, P = 0. 178）. The mean operation time of the supracostal group was （78.6 ±5.1 ） min, while that of the subcostal group was （102.4 7.1 ） min （ t = - 20. 454,P = 0. 000）. There was one patient in each group received blood transfusion. One patient in the supracostal group had pneumothorax and recovered uneventfully by conservative treatments. Conclusion Ultrasonography-guided PCNL via the supracostal approach is effective and safe with short operation time.