两种方法建立操作通道行PCNL的比较研究

Comparing of two technologies in preparing working channel for percutaneous nephroscopy

目的:比较B超引导及B超引导+全尿路会师贯通技术建立操作通道行PCNL治疗肾结石的疗效,探讨全尿路会师贯通技术建立操作通道行PCNL的优势。方法:2008年10月～2011年10月行PCNL治疗肾结石患者115例,依据穿刺引导方法的不同分为A、B两组,其中超声引导组61例(A组),结石位于左侧27例,右侧24例,双侧10例,结石平均大小2.9(3.0±0.6)cm;超声引导+全尿路会师贯通技术组(B组)54例,结石位于左侧20例,右侧22例,结石平均大小2.8(2.9±0.6)cm。两组均扩张通道至F24,置入F22工作鞘、F20和F08肾镜,采用气压弹道及超声碎石取石,比较两组穿刺时间、穿刺成功率、并发症发生率、取石成功率(无石率+无意义残石率)。结果:穿刺时间:A组9.4(10.4±4.2)min,B组6.6(6.2±3.8)min(P>0.05);一次穿刺成功率:A组73.7%(45/61),B组94.4%(51/54)(P<0.05);并发症发生率:A组16.4%(10/61),B组5.0%(2/54);取石成功率:A组80.3%(49/61),B组92.5%(50/54)。结论:B超引导+全尿路会师贯通术建立操作通道行PCNL可明显提高PCNL手术效率,减少并发症的发生。

Objective：To evaluate the efficacy and safety of total urinary tract breaking-through combined with ultrasonic guidance for the establishment of working channel for percutaneous nepbroscopy, compared with singly ultrasonic guidance. Method： One hundred and fifteen patients accepted minimally invasive percutaneous nephro- lithotomy during 2008.10 to 2011.10. Based on the different guidances of punctures, the patients were divided randomly into two groups. A group： 61 cases, 40 male and 21 female, 27 patients with left side, 24 patients with right side, and 10 patients with bilateral calculi. The average size of calculi was 2.9 cm. All the patients accepted punctures by singly ultrasonic guidance. B group= 54 cases, 34 male and 20 female, 20 patients with left side, 22 patients with right side and 12 patients with bilateral calculi. The average size of calculi was 2.8 cm. All the pa- tients accepted punctures by ultrasonic guidance combined with total urinary tract breaking-through. In both groups, F24 Working channel for percutaneous nephroscopy was established,then put in F2z working sheath, used F20.8 nephrolithotomy to carry out pneumatic lithotripsy or ultrasonic lithotripsy. Result=Puncture time： A group 9.4（10.4±4.2）min, B group 6.6（6.2±3.8）min（P〈0.05） ; Once puncture success rate= A group 73.7 %（45/ 61）, B group 94.4% （51/54） （P〈0.05）; Complication rate： A group 16.4% （10/61）, B group 5.0% （2/54） （P〈0.05） ; Clearance rate.. A group 80.3%（49/61）, B group 92.5%（50/54）（P〈0.05）. Conclusion.. Total urinary tract breaking-through combined with ultrasonic guidance for establishing working channel for percutaneous nephroscopy can improve the efficacy of PCNL and reduce complication rate.