超声引导球囊扩张器下经皮肾镜取石术的效果与安全性

Balloon dilator in ultrasound-guided minimally invasive percutaneous nephrolithotomy lithotomy Applications

目的探讨超声引导球囊扩张器下微创经皮肾镜治疗肾结石手术的效果与安全性。方法收集98例肾结石患者并分成两组。在超声引导下经皮肾镜手术用连续筋膜扩张器建立通道的为组1(48例),用球囊扩张器建立通道的为组2(50例)。术前和术后结石的评价通过彩超、腹部平片、CT检查。术中失血量通过基础血红蛋白的减少进行评价。操作速度通过通道建立时间和手术持续时间进行测量对比。通过患者的性别、年龄、结石的位置、结石的症状(均P>0.05)对两组进行比较。结果在所有的患者中通道建立均一次成功,在缩短通道建立时间(F=100.390,P=0.000)和手术时间(F=4.038,P=0.047),提高结石清除率(=4.443,P=0.035),避免肾脏集合系统副损伤(=5.488,P=0.019),减少术中失血(F=9.201,P=0.003)等方面组2明显好于组1。结论球囊扩张器安全、可靠,可用于超声引导下微创经皮肾镜取石术。

Objective We evaluated the effectiveness and safety of balloon dilation in ultrasound-guided minimally invasive PCNL for the treatment of renal calculi.Methods Ninety-eight patients with renal calculi were enrolled and divided into two groups.These patients underwent ultrasound-guided PCNL and were performed with sequential fascial dilators（Group I,n = 48） or balloon dilators（Group II,n = 50）.Preoperative and postoperative evaluations of calculi included color ultrasound,plain abdominal radiography,and computed tomography.Intraoperative blood loss was evaluated by analyzing the decrease in hemoglobin compared with the baseline level.Manipulation speed was measured by tract establishment duration and operation duration.Results The two groups were compared in terms of age,gender,calculi location,and calculi burden（P 0.05,all）.Tracts in all patients were successfully established in the first attempt,and no rupture of the colon or pleura occurred.Balloon dilation was significantly superior to sequential fascial dilation in shortening the cannulation duration（F = 100.390,P = 0.000） and operation duration（F = 4.038,P = 0.047）,increasing the stone-free rate（= 4.443,P = 0.035）,avoiding rupture of the renal collection system（= 5.488,P = 0.019）,and reducing intraoperative blood loss（F = 9.201,P = 0.003）.Conclusion Compared with sequential fascial dilation,balloon dilation is more applicable in ultrasound-guided minimally invasive PCNL.