术中超声与X线定位下经皮肾镜取石术治疗肾结石的对比研究

The comparative analysis of ultrasound and X-ray guided percutaneous nephrolithotomy in the treatment of renal calculus

目的:对比分析超声与X线定位下经皮肾镜取石术治疗肾结石的疗效与并发症。方法:回顾分析2007年6月至2012年6月为532例肾结石患者行经皮肾镜取石术的临床资料。对比分析术中超声与X线定位下经皮肾镜取石术的穿刺时间、一次性穿刺成功率、接受X线照射时间、取石成功率、术中出血量、严重并发症发生率。结果:X线定位组穿刺时间平均(7.9±0.6)min,超声组平均(4.3±0.4)min,两组相比差异有统计学意义(P<0.01);一次性穿刺成功率X线定位组为81.3%,超声组为87.6%,差异有统计学意义(P<0.05);X线定位组术中出血量平均(134±12)ml,超声组平均(97±9)ml,差异有统计学意义(P<0.05);X线定位组术者X线暴露时间平均(4.9±1.3)min,超声组无暴露。取石成功率及严重并发症发生率两组差异无统计学意义(P>0.05)。结论:与X线定位相比,B超定位下经皮肾镜取石术操作简单,成功率高,安全可靠,值得推广;但学习曲线相对较长,经过系统地熟悉超声原理及准确定位后,可提高手术速度与效果。

Objective: To compare and analyze the clinical efficacy and complications of ultrasound and X-ray guided percutaneous nephrolithotomy in the treatment of kidney calculi.Methods: The clinical data of 532 adult patients who suffered from kidney calculi and underwent percutaneous nephrolithotomy from Jun.2007 to Jun.2012 were retrospectively analyzed.Time of establishment of renal track,the success rate of one-time puncture,time of X-ray exposure,rate of stone clearance,blood loss,rate of serious complications were observed and compared between ultrasound and X-ray guided percutaneous nephrolithotomy.Results: Time of renal track establishment in X-ray group was(7.9 ± 0.6) min,ultrasound group was(4.3 ± 0.4) min with statistically significant difference(P < 0.01);the success rate of one-time puncture in X-ray group was 81.3% and ultrasound group was 87.6%,with statistically significant difference(P < 0.05);blood loss in X-ray group was(134 ± 12) ml and ultrasound group was(97 ± 9) ml with statistically significant difference(P < 0.05);average time of X-ray exposure in X-ray group was(4.9 ± 1.3) min,which in ultrasound group was 0 min.Differences in rate of stone clearance and serious complications were not statistically significant(P > 0.05).Conclusions: Ultrasoundguided percutaneous nephrolithotomy is easier,safer and more reliable with higher success rate than X-ray guided percutaneous nephrolithotomy.The learning curve of ultrasound-guided procedure is longer,the speed and effect of operation can be improved after systematic acquaintance of the ultrasound principle and accurate positioning.